title: Dipyridamole coronary flow reserve stratifies prognosis in acute coronary syndrome patients without left anterior descending disease.
abstract: OBJECTIVE
  Coronary flow reserve (CFR) assessment by transthoracic ultrasound of the left anterior descending (LAD) artery during dipyridamole stress echocardiography has been shown to predict prognosis in large unselected populations. Low values of CFR are strongly correlated with significant stenosis of the LAD; aim of the present study was to assess the prognostic impact of CFR in patients recovering from an acute coronary syndrome (ACS) with proven absence of LAD disease.
  
  
  METHODS
  From an overall cohort of 325 patients with ACS who underwent a high-dose dipyridamole stress with combined assessment of CFR in the LAD and wall motion, 152 patients without LAD disease (stenosis <50%) were included in the present analysis; all subjects underwent coronary angiography and were subsequently monitored for the incidence of major cardiac events (MACE).
  
  
  RESULTS
  After a median follow-up of 29 months, 22 patients developed MACE. Patients who experienced MACE differed from stable patients in terms of age, prevalence of diabetes, and CFR. Receiver-operating characteristic curve analysis defined a CFR <2.25 as the optimal cut point for prediction of MACE. Cox multivariable analysis for the prediction of MACE demonstrated independent predictive value only for CFR <2.25, smoking status, and number of stenotic vessels at angiogram.
  
  
  CONCLUSIONS
  In high-risk patients with ACS, even in the absence of LAD disease, CFR significantly improves prediction of adverse events when added to standard evaluation. This finding supports a role of CFR in the risk stratification early after ACS and is in context with the concept that CFR reflects global atherosclerotic burden, endothelial dysfunction, and microvascular damage, more than just mirroring focal LAD disease.
authors.affiliation: Department of Cardiology, Monaldi Hospital, AORN Ospedali dei Colli, Via Leonardo Bianchi, Naples 80131, Italy. luigi.ascione20@tin.it
authors.forename: Luigi
authors.initials: L
authors.lastname: Ascione
authors.forename: Guido
authors.initials: G
authors.lastname: Carlomagno
authors.forename: Chiara
authors.initials: C
authors.lastname: Sordelli
authors.forename: Raffaele
authors.initials: R
authors.lastname: Iengo
authors.forename: Vittorio
authors.initials: V
authors.lastname: Monda
authors.forename: Sergio
authors.initials: S
authors.lastname: Severino
authors.forename: Raffaele
authors.initials: R
authors.lastname: Merenda
authors.forename: Antonello
authors.initials: A
authors.lastname: D'Andrea
authors.forename: Pio
authors.initials: P
authors.lastname: Caso
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000628:therapy; D017023:Coronary Angiography; D004176:Dipyridamole; D018450:Disease Progression; D025401:Echocardiography, Stress; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014665:Vasodilator Agents
chemical_list: D014665:Vasodilator Agents; D004176:Dipyridamole
keywords: acute coronary syndrome; coronary flow reserve; dipyridamole stress echo; endothelial dysfunction; prognosis