title: Prognostic value of coronary blood flow velocity and myocardial perfusion in intermediate coronary narrowings and multivessel disease.
abstract: OBJECTIVE
  This study aimed to investigate the roles of intracoronary derived coronary flow velocity reserve (CFVR) and myocardial perfusion scintigraphy (single photon emission computed tomography, or SPECT) for management of an intermediate lesion in patients with multivessel coronary artery disease.
  
  
  BACKGROUND
  Evaluation of the functional significance of intermediate coronary narrowings (40% to 70% diameter stenosis) is important for clinical decision making and risk stratification.
  
  
  METHODS
  In a prospective, multicenter study, SPECT was performed in 191 patients with stable angina and multivessel disease and scheduled for angioplasty (percutaneous transluminal coronary angioplasty, or PTCA) of a severe coronary narrowing. Coronary flow velocity reserve was determined selectively distal to an intermediate lesion in another artery using a Doppler guidewire. Percutaneous transluminal coronary angioplasty of the intermediate lesion was deferred when SPECT was negative or CFVR greater-than-or-equal 2.0. Patients were followed for one year to document major cardiac events (death, infarction, revascularization), related to the intermediate lesion.
  
  
  RESULTS
  Reversible perfusion defects were documented in the area of the intermediate lesion in 30 (16%) patients; CFVR was positive in 46 (24%) patients. Percutaneous transluminal coronary angioplasty of the intermediate lesion was deferred in 182 patients. During follow-up, 19 events occurred (3 myocardial infarctions, 16 revascularizations). Coronary flow velocity reserve was a more accurate predictor of cardiac events than was SPECT; relative risk: CFVR 3.9 (1.7 to 9.1), p < 0.05; SPECT 0.5 (0.1 to 3.2), p = NS. Multivariate analysis revealed CFVR as the only significant predictor for cardiac events.
  
  
  CONCLUSIONS
  Deferral of PTCA of intermediate lesions in multivessel disease is safe when CFVR greater-than-or-equal 2.0 (event rate 6%). This selective evaluation of coronary lesion severity during cardiac catheterization allows a more accurate risk stratification than does SPECT, which is important for clinical decision making in this patient cohort.
authors.affiliation: Departments of Cardiology, Academic Medical Center-University of Amsterdam, The Netherlands. s.a.chamuleau@amc.uva.nl
authors.forename: Steven A J
authors.initials: SA
authors.lastname: Chamuleau
authors.forename: Rene A
authors.initials: RA
authors.lastname: Tio
authors.forename: Carel C
authors.initials: CC
authors.lastname: de Cock
authors.forename: Ebo D
authors.initials: ED
authors.lastname: de Muinck
authors.forename: Nico H J
authors.initials: NH
authors.lastname: Pijls
authors.forename: Berthe L F
authors.initials: BL
authors.lastname: van Eck-Smit
authors.forename: Karel T
authors.initials: KT
authors.lastname: Koch
authors.forename: Martijn
authors.initials: M
authors.lastname: Meuwissen
authors.forename: Marcel G W
authors.initials: MG
authors.lastname: Dijkgraaf
authors.forename: Angelina
authors.initials: A
authors.lastname: de Jong
authors.forename: Hein J
authors.initials: HJ
authors.lastname: Verberne
authors.forename: Rob A M
authors.initials: RA
authors.lastname: van Liebergen
authors.forename: Gert Jan
authors.initials: GJ
authors.lastname: Laarman
authors.forename: Jan G P
authors.initials: JG
authors.lastname: Tijssen
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Piek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D001783:Blood Flow Velocity / Q000502:physiology; D006328:Cardiac Catheterization; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000628:therapy; D003326:Coronary Circulation / Q000502:physiology*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome