(Circulation. 2000;101:962.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Prediction of Restenosis After Coronary Angioplasty by Use of a New Index
TIMI Frame Count/Minimal Luminal Diameter Ratio
Presented in part at the XIXth European Congress of Cardiology, Stockholm, August 24–28, 1997.
From the 1st Cardiology Department, Onassis Cardiac Surgery Center (A.M., V.V., G.P., G.A., D.V.C.), Athens, Greece, and the Institute of Cardiovascular Diseases, University Clinical Center (G.S., M.O.), Belgrade, Yugoslavia.
Correspondence to Dennis V. Cokkinos, MD, Professor of Cardiology, University of Athens, 1st Cardiology Department, Onassis Cardiac Surgery Center, 356 Sygrou Ave, 176 74 Athens, Greece.
Background—It has been shown recently that postangioplasty coronary flow reserve and the degree of residual stenosis have a modest predictive value for short- and long-term clinical outcomes after coronary angioplasty. Corrected TIMI frame count (CTFC) is a simple quantitative index of coronary blood flow. Its relationship with Doppler coronary flow velocity and clinical outcome after coronary angioplasty has not been fully clarified. The aim of this study was to identify clinical, angiographic, and functional predictors of clinical and angiographic restenosis after conventional coronary angioplasty.
Methods and Results—We studied 70 consecutive patients in whom intracoronary Doppler flow-velocity measurements were performed before and after angioplasty. Patients were evaluated for restenosis by clinical follow-up, exercise stress test/201Tl scintigraphy, and follow-up angiography, which was performed at 10.5±10.3 months in 63 patients. According to the results of univariate analysis, a new index, postangioplasty CTFC/minimal luminal diameter (MLD) ratio, was created. Multivariate analysis revealed that CTFC/MLD ratio was the only independent predictor of angiographic (OR 2.02; 95% CI 1.37 to 2.97; P<0.0004) and clinical (OR 1.60; 95% CI 1.15 to 2.21; P<0.005) restenosis. The receiver operating characteristic curve area of this index was 79% for angiographic and 73% for clinical restenosis. The optimal CTFC/MLD ratio cutoff values were 7.88 for angiographic and 7.94 for clinical restenosis, respectively.
Conclusions—Our data indicate that postangioplasty CTFC/MLD ratio, which incorporates both the angiographic and functional features of coronary lesions, is a reliable, objective, and inexpensive index for prediction of angiographic and clinical restenosis after conventional coronary angioplasty.
Key Words: angioplasty • blood flow • restenosis • coronary disease
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