(Circulation. 2001;103:1212.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Intracoronary Doppler– and Quantitative Coronary Angiography–Derived Predictors of Major Adverse Cardiac Events After Stent Implantation
From the Cardiology Department, University of Essen, Essen, Germany (M.H., D.B., R.E.); Ospedale di Circolo, Varese, Italy (E.V.); Academic Medical Center, Amsterdam, Netherlands (J.J.P.); Universitair Ziekenhuis, Antwerpen, Belgium (C.V.); and Kardiologische Universitätsklinik, Allgemeines Krankenhaus, Wien, Austria (P.P.).
Correspondence to Michael Haude, MD, Cardiology Department, University of Essen, Hufelandstraße 55, 45122 Essen, Germany.
Background—Distal
coronary flow velocity reserve (CVR) is significantly improved after a
successful balloon angioplasty (PTCA). Furthermore, a
postinterventional CVR >2.5 and a percent diameter stenosis (%DS)
35% are predictive for a low incidence of major adverse cardiac
events (MACE) at 6 months of 16%. Similar results are lacking for
coronary stenting.
Methods and Results—In
150 patients, baseline and hyperemic coronary flow velocities were
recorded with a Doppler guidewire distal to the target lesion and in an
unobstructed reference artery before and after PTCA, after stenting,
and at 6 months. Distal CVR and relative CVR
(CVRrel) were calculated. Logistic regression
and receiver operating characteristic analyses were applied to
determine prognostic cutoff values of CVR,
CVRrel, %DS, and minimal lumen diameter
separately and in combination to predict MACE at 6 months. After
stenting, CVR (2.96±0.87 versus 2.40±0.7;
P=0.001),
CVRrel (1.02±0.24 versus 0.81±0.24;
P=0.001), and minimal lumen
diameter (2.98±0.56 versus 2.11±0.74 mm;
P=0.001) were significantly
higher than after PTCA. Thirty-three patients developed MACE. A
postinterventional CVRrel>0.88 was the best
single predictor of MACE, with an incidence of 6.8%, whereas the
combination of a CVRrel>0.88 and a %DS
11.2% predicted an incidence of MACE of
1.5%.
Conclusions—Measurement of CVRrel and %DS after stent implantation are best suitable to predict MACE at 6 months.
Key Words: stents • blood flow • restenosis • angioplasty • prognosis
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