[Late recovery of coronary flow reserve in patients successfully treated with a percutaneous procedure].
OBJECTIVE
Coronary angiograms are of limited value for the assessment of the results of percutaneous interventions. Intracoronary Doppler studies have been used to overcome these difficulties. The achievement of a coronary flow reserve (CFR) > 2-2.5 after the procedure is considered a good result and further optimization is generally not required. However, coronary flow reserve may not recover immediately, despite optimal procedural results. The aim of this study is to assess the temporal course of the recovery of coronary flow reserve after successful revascularization.


METHODS
We studied 34 patients with coronary heart disease who were successfully treated by balloon angioplasty (n = 8) or stent implantation (n = 26). In all patients, serial observations were made by quantitative angiography and intracoronary Doppler (0.014 = flow-wire). Patients were studied: a) before treatment; b) immediately after, and c) 8 3 months later.


RESULTS
The baseline coronary flow reserve was 1.3 0.4 and increased to 2.4 0.8 after the procedure (p < 0.01). At 8 months follow-up there was a significant increase (3 0.8; p < 0.01). This late improvement in coronary flow reserve was associated with a decline in average peak velocity at follow-up. Patients with impaired CFR immediately after treatment had a greater increase in CFR during followup than those with CFR > 2 after treatment (1.4 0.9 vs 0.4 0.6; p < 0.01).


CONCLUSIONS
After a successful coronary intervention, CFR increases immediately, but some patients may experience additional improvement during follow-up. This increase was greater in patients who showed less improvement in coronary flow reserve immediately after treatment. Our findings suggest that the use of Doppler parameters in the immediate assessment of percutaneous coronary intervention results have limitations.
Servicio de Cardiología. Hospital Universitario Reina Sofía. Córdoba. España.
Manuel
M
Pan
José
J
Suárez de Lezo
Alfonso
A
Medina
Miguel
M
Romero
José
J
Segura
Djordje
D
Pavlovic
Enrique
E
Hernández
Juan
J
Muñoz
Marcos
M
Rodríguez
Carmen
C
Rus
Mónica
M
Delgado
Soledad
S
Ojeda
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology*; D003327:Coronary Disease / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D017078:Laser-Doppler Flowmetry; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome