Published online before print March 11, 2002, doi: 10.1161/01.CIR.0000012514.15806.DD
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(Circulation. 2002;105:1573.)
© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
Coronary Flow Velocity Reserve After Percutaneous Interventions Is Predictive of Periprocedural Outcome
From Thoraxcenter, Rotterdam, the Netherlands (M.A., G.V.L., P.I.K., M.A.C., E.B., T.B., P.W.S.); the Academic Medical Center, Amsterdam, the Netherlands (M.V., J.J.P.); Onze Lieve Vrouwe Kliniek, Aalst, Belgium (B.d.B.); institutop Dante Pazzanesse de Cardiologia, San Pablo, Brasil (J.E.S.); and the Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina (J.A.B.).
Correspondence to P.W. Serruys, MD, PhD, FACC, FESC, Professor of Interventional Cardiology, Head of Interventional Department, Thoraxcenter, Bd 418, University Hospital Dijkzigt, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. E-mail serruys{at}card.azr.nl
Background— Because heterogeneous results have been reported, we assessed coronary flow velocity changes in individuals who underwent percutaneous transluminal coronary angioplasty (PTCA) and examined their impact on clinical outcome.
Methods and Results— As part of the Doppler Endpoints Balloon Angioplasty Trial Europe (DEBATE) II study, 379 patients underwent Doppler flow–guided angioplasty. All patients were evaluated according to their coronary flow velocity reserve (CFVR) results (
2.5 or <2.5) at the end of the procedure. A CFVR <2.5 after angioplasty was associated with an elevated baseline blood flow velocity in both the target artery and reference artery. CFVR before PTCA and CFVR in the reference artery were independent predictors of an optimal CFVR after balloon angioplasty (CFVR before PTCA: odds ratio [OR], 2.26; 95% confidence interval [CI], 1.57 to 3.24; CFVR in reference artery: OR, 1.90; 95% CI, 1.21 to 2.98; both P<0.001) and stent implantation (before PTCA: OR, 2.54; 95% CI, 1.47 to 4.36; reference artery: OR, 1.97; 95% CI, 1.07 to 3.87; both P<0.05). A low CFVR at the end of the procedure was an independent predictor of major adverse cardiac events (MACE) at 30 days (OR, 4.71; 95% CI, 1.14 to 25.92; P=0.034) and at 1 year (OR, 2.06; 95% CI, 1.16 to 3.66; P=0.014). After excluding MACE at 30 days, no difference in MACE at 1 year was observed between the patients with and without a CFVR <2.5 at the end of the procedure.
Conclusions— A low postprocedural CFVR was associated with a worse periprocedural outcome (which was related to microcirculatory disturbances), but there was no significant difference at late follow-up.
Key Words: angiography • imaging • microcirculation
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