Intracoronary Doppler- and quantitative coronary angiography-derived predictors of major adverse cardiac events after stent implantation.
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.


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.
Haude
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Cardiology Department, University of Essen, Essen, Germany.
Baumgart
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D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001783:Blood Flow Velocity / Q000502:physiology; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology*; D003327:Coronary Disease / Q000503:physiopathology / Q000628:therapy*; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015607:Stents