Key result
Depressed coronary flow reserve linked to ~108% higher risk of target vessel failure regardless of LVEF.
Why the study?
Intracoronary physiologic indexes like CFR and LVEF are prognostic in coronary artery disease, but the association between them and their differential prognostic implications needed evaluation.
Does depressed coronary flow reserve (CFR ≤2.0) predict target vessel failure in patients with coronary artery disease regardless of left ventricular ejection fraction?
Observational (n=1,889)
Yes
Does depressed coronary flow reserve (CFR ≤2.0) predict target vessel failure in patients with coronary artery disease regardless of left ventricular ejection fraction?
Depressed coronary flow reserve is a strong independent predictor of target vessel failure in patients with coronary artery disease, regardless of whether left ventricular ejection fraction is preserved or reduced.
Reduced CFR may flag higher-risk vessels independent of LVEF; extends prognostic data but remains hypothesis-generating and should not yet change practice.
Background Intracoronary physiologic indexes such as coronary flow reserve (CFR) and left ventricular ejection fraction (LVEF) have been regarded as prognostic indicators in patients with coronary artery disease. The current study evaluated the association between intracoronary physiologic indexes and LVEF and their differential prognostic implications in patients with coronary artery disease. Methods and Results A total of 1889 patients with 2492 vessels with available CFR and LVEF were selected from an international multicenter prospective registry. Baseline physiologic indexes were measured by thermodilution or Doppler methods and LVEF was recorded at the index procedure. The primary outcome was target vessel failure, which was a composite of cardiac death, target vessel myocardial infarction, or clinically driven target vessel revascularization over 5 years of follow‐up. Patients with reduced LVEF <50% (162 patients [8.6%], 202 vessels [8.1%]) showed a similar degree of epicardial coronary artery disease but lower CFR values than those with preserved LVEF (2.4±1.2 versus 2.7±1.2, P <0.001), mainly driven by the increased resting coronary flow. Conversely, hyperemic coronary flow, fractional flow reserve, and the degree of microvascular dysfunction were similar between the 2 groups. Reduced CFR (≤2.0) was seen in 613 patients (32.5%) with 771 vessels (30.9%). Reduced CFR was an independent predictor for target vessel failure (hazard ratio, 2.081 [95% CI, 1.385–3.126], P <0.001), regardless of LVEF. Conclusions CFR was lower in patients with reduced LVEF because of increased resting coronary flow. Patients with reduced CFR showed a significantly higher risk of target vessel failure than did those with preserved CFR, regardless of LVEF. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04485234.
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Joh et al. (2022) conducted an observational in Coronary artery disease (n=1,889). Depressed coronary flow reserve (≤2.0) vs. Preserved coronary flow reserve (>2.0) was evaluated on Target vessel failure (composite of cardiac death, target vessel myocardial infarction, or clinically driven target vessel revascularization) (HR 2.081, 95% CI 1.385-3.126, p=<0.001). Depressed coronary flow reserve (≤2.0) was independently associated with a significantly higher risk of target vessel failure (HR 2.081) compared to preserved coronary flow reserve, regardless of left ventricular ejection fraction.
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