Key result
Impaired coronary flow reserve affects ~40% of post-MI patients, strongly predicted by incomplete revascularization.
Why the study?
Understanding the prevalence of impaired CFR and identifying risk markers for it are needed to develop personalized treatments for high-risk patients with prior MI.
What is the prevalence of impaired coronary flow reserve and its predictors in high-risk patients with prior myocardial infarction?
Cross-Sectional (n=619)
Open-label
Yes
What is the prevalence of impaired coronary flow reserve and its predictors in high-risk patients with prior myocardial infarction?
Answers are grounded in this paper and cite their sources.
A substantial proportion of high-risk patients with prior MI have impaired coronary flow reserve despite optimal medical therapy and lack of angina, suggesting a potential role for CFR in further risk stratification.
BACKGROUND: Survivors of myocardial infarction (MI) are at high risk of new major adverse cardiovascular events (MACE). Coronary flow reserve (CFR) is a strong and independent predictor of MACE. Understanding the prevalence of impaired CFR in this patient group and identifying risk markers for impaired CFR are important steps in the development of personalized and targeted treatment for high-risk individuals with prior MI. METHODS: PROFLOW is a prospective, exploratory, cross-sectional open study. We used information from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry) to identify high-risk patients with a history of type-1 MI. We measured CFR non-invasively in a left anterior descending artery (LAD) using transthoracic Doppler echocardiography. Coronary flow velocity was measured at rest and at maximal flow after induction of hyperemia by intravenous infusion of adenosine (140 μg/kg/min). Independent predictors of CFR were assessed with multiple linear regression. RESULTS: We included 619 patients. The median age was 69 (IQR 65-73), and 114 (18.4%) were women. Almost one-half of the patients, 285 (46.0%) had the multi-vessel disease, and 147 (23.7%) were incompletely revascularized. The majority were on optimal standard treatment eg ASA (93.1%), statins (90.0%), ACEI/ARB (82.6%) and beta-blockers (80.8%). The majority, 547 (88.4%) had no angina pectoris, and 572 (92.2%) were in NYHA class I. Evaluation of CFR was possible in 611 (98.7%) patients. Mean CFR was 2.74 (±0.79 (mean ± SD)). A substantial number of patients (39.7%) had CFR ≤2.5. In a multiple linear regression model age, dyslipidemia, smoking, hypertension, body mass index, incomplete revascularization, and treatment with angiotensin receptor blockers were independent predictors of CFR. CONCLUSION: In this high-risk group of patients with prior MI, the prevalence of impaired CFR was high. Further risk stratification with CFR in addition to traditional cardiovascular risk factors may improve predictive accuracy for future MACE in this patient population.
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Haraldsson et al. (2019) conducted a cross-sectional in Established coronary artery disease with prior type-1 myocardial infarction (n=619). Non-invasive transthoracic Doppler echocardiography evaluation of coronary flow reserve (CFR) and risk factors (e.g., incomplete revascularization) vs. Normal coronary flow reserve (CFR >2.5) / complete revascularization was evaluated on Prevalence of impaired coronary flow reserve (CFR ≤2.5) in the left anterior descending artery. Impaired coronary flow reserve was present in 39.7% of high-risk post-MI patients, with incomplete revascularization being a strong independent predictor.
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