(Circulation. 1996;94:286-297.)
© 1996 American Heart Association, Inc.
Articles |
Comparison of Myocardial Perfusion Reserve Before and After Coronary Balloon Predilatation and After Stent Implantation in Patients With Postangioplasty Restenosis
the Cardiology Department, University of Essen (M.H., G.C., D.B., R.E.), and the Second Medical Clinic, Johannes Gutenberg University, Mainz (R.B., J.M.), Germany.
Correspondence to Michael Haude, MD, Cardiology Department, University of Essen, Hufelandstr 55, 45122 Essen, Federal Republic of Germany.
Background Stents provide a scaffold for coronary arteries after angioplasty and inhibit elastic recoil.
Methods and Results In 25 patients with postangioplasty restenosis of the left anterior descending artery, ECG-gated digital subtraction coronary angiograms were recorded at baseline and during hyperemia (12 mg papaverine IC) before and after balloon predilatation (PTCA), after implantation of a Palmaz-Schatz stent, and after 6 months. Densitometric evaluation revealed different time and density parameters to calculate two definitions of myocardial perfusion reserve (MPR1 and MPR2) and maximum flow ratio (MaxFR). Poststenotic MPR1 increased from 1.57±0.14 to 2.59±0.86 after PTCA and to 3.10±0.41 after stenting, with 2.90±0.65 at follow-up (ANOVA, P<.05), while reference MPR1 remained unchanged at 3.10±0.40. Poststenotic MPR2 increased from 1.36±0.28 to 2.50±1.20 and to 3.40±0.58, respectively, with 3.20±0.92 at follow-up (ANOVA, P<.05), while reference MPR2 remained unchanged at 3.40±0.60. MaxFR was 2.13±0.53 after PTCA, 2.83±0.35 after stenting, and 2.73±0.58 at follow-up (ANOVA, P<.05). A good correlation was found between minimal stenotic luminal diameter and MPR1 or MPR2 (r=.87 and r=.94) and between luminal gain and MaxFR (r=.75). A negative correlation was measured between recoil and MPR1, MPR2, and MaxFR (r=-.80, r=-.86, and r=-.83). At follow-up, a steeper correlation was found between MPR and minimal stenosis diameter (MPR1: slope, 0.52 versus 0.91; MPR2: slope, 1.48 versus 1.95) and between MaxFR and net lumen gain (slope, 0.78 versus 1.27).
Conclusions Coronary stent implantation in patients with postangioplasty restenosis normalized poststenotic myocardial perfusion immediately as a result of a larger postprocedural lumen and a more pronounced inhibition of elastic recoil. After 6 months this benefit was sustained despite progressive lumen loss.
Key Words: perfusion • angioplasty • stents • elasticity
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