Recruitable collateral blood flow index predicts coronary instent restenosis after percutaneous coronary intervention.
OBJECTIVE
Collateral flow may influence long-term results after percutaneous coronary intervention (PCI) because of haemodynamic forces compete with the antegrade flow through the dilated lesion. The aim of the study was to assess the influence of recruitable collateral blood flow on restenosis in patients undergoing PCI with bare metal stents and using optimal antithrombotic treatment.


RESULTS
In 95 patients, 95 de novo lesions were treated with PCI and a bare metal stent. Fractional flow reserve (FFR) at maximum hyperaemia induced by intravenous adenosine was determined. The pressure-derived collateral flow index (CFI) was determined as (P(w)-P(cvp))/(P(a)-P(cvp)), where P(w) represents coronary wedge pressure, P(cvp) central venous pressure, and P(a) mean aortic blood pressure. Both were measured during transient coronary occlusion by a balloon inflation of 30 s. Pre-interventional FFR (0.65 +/- 0.20) correlated inversely with the CFI (0.18 +/- 0.11), r =- 0.356, P < 0.001. After 9 months, binary angiographic restenosis (>/=50% diameter stenosis) was seen in 29.1%. Compared to patients with poorly developed collaterals (CFI < 0.25), patients with well-developed collaterals (CFI >/= 0.25) had a lower pre-interventional FFR (0.50 +/- 0.14 vs. 0.72 +/- 0.18, P < 0.001), a higher CFI (0.33 +/- 0.08 vs. 0.13 +/- 0.07, P < 0.001), and a higher binary restenosis rate (54.2% vs. 19.4, P = 0.003). CFI*100 was an independent predictor of restenosis after 9 months (odds ratio 1.07, 95% CI 1.02-1.12, P = 0.016).


CONCLUSIONS
Recruitable collateral blood flow measured during balloon inflation predicts angiographic instent restenosis in PCI patients treated with bare metal stents.
Jensen
Lisette Okkels
LO
Department of Cardiology, Catheterization Laboratory, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark. okkels@dadlnet.dk
Thayssen
Per
P
Lassen
Jens Flensted
JF
Hansen
Henrik Steen
HS
Kelbaek
Henning
H
Junker
Anders
A
Pedersen
Knud Erik
KE
Hansen
Knud Nørregaard
KN
Krusell
Lars Romer
LR
Botker
Hans Erik
HE
Thuesen
Leif
L
D015906:Angioplasty, Balloon, Coronary; D002496:Central Venous Pressure; D003097:Collateral Circulation; D017023:Coronary Angiography; D023903:Coronary Restenosis; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors