Key result
A postinterventional relative coronary flow velocity reserve >0.88 combined with a percent diameter stenosis ≤11.2% after stenting predicted a low 1.5% incidence of major adverse cardiac events at 6 months.
Why the study?
Do postinterventional relative coronary flow velocity reserve and percent diameter stenosis predict major adverse cardiac events at 6 months in patients undergoing coronary stenting?
Cohort (n=150)
Do postinterventional relative coronary flow velocity reserve and percent diameter stenosis predict major adverse cardiac events at 6 months in patients undergoing coronary stenting?
Postinterventional relative coronary flow velocity reserve and percent diameter stenosis are strong predictors of 6-month major adverse cardiac events after coronary stenting.
May identify low-risk post-stent patients; hypothesis-generating and requires prospective validation before practice change.
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 (CVR(rel)) were calculated. Logistic regression and receiver operating characteristic analyses were applied to determine prognostic cutoff values of CVR, CVR(rel), %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), CVR(rel) (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 CVR(rel)>0.88 was the best single predictor of MACE, with an incidence of 6.8%, whereas the combination of a CVR(rel)>0.88 and a %DS </=11.2% predicted an incidence of MACE of 1.5%. CONCLUSIONS: Measurement of CVR(rel) and %DS after stent implantation are best suitable to predict MACE at 6 months.
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Haude et al. (2001) conducted a cohort in Coronary artery disease undergoing angioplasty and stenting (n=150). Postinterventional relative coronary flow velocity reserve (CVRrel) and percent diameter stenosis (%DS) was evaluated on Major adverse cardiac events (MACE) at 6 months. A postinterventional relative coronary flow velocity reserve >0.88 combined with a percent diameter stenosis ≤11.2% after stenting predicted a low 1.5% incidence of major adverse cardiac events at 6 months.
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