Prognostic impact and clinical outcomes of coronary flow reserve and hyperaemic microvascular resistance.

Abstract

BACKGROUND:

Most studies dichotomise indices of coronary microvascular function to assess their prognostic values.

AIMS:

We aimed to investigate whether coronary flow reserve (CFR) and hyperaemic microvascular resistance (HMR) as continua predict major adverse cardiovascular events (MACE), comprising all-cause death, myocardial infarction, revascularisation, and stroke in patients with ischaemia and non-obstructive coronary artery disease.

METHODS:

A total of 610 patients were included and followed up over a median of 8.0 years (199 individual MACE in 174 patients).

RESULTS:

Both CFR and HMR as continua predicted MACE with an odds ratio (OR) of 0.70 (per 1-unit increase, 95% confidence interval [CI]: 0.53, 0.92; p=0.01) and 1.63 (per 1 mmHg/cm/s, 95% CI: 1.20, 2.21; p=0.002), respectively. This relationship remained significant after adjustment for age and sex with an adjusted OR of 0.66 (per 1 unit increase, 95% CI: 0.49, 0.89; p=0.01) and 1.42 (per 1 mmHg/cm/s, 95% CI: 1.03, 1.94; p=0.03). HMR added prognostic value to CFR in predicting MACE (net reclassification index 0.17, 95% CI: 0.02, 0.31; p=0.03; integrated discrimination improvement 0.01, 95% CI: 0.0001, 0.02; p=0.046).

CONCLUSIONS:

Both CFR and HMR as continuous variables predict future risk of MACE.

• Authors: Takumi Toya, Michel T Corban, Ji Young Park, Ali Ahmad, Ilke Ӧzcan, Faten Sebaali, Jaskanwal D S Sara, Rajiv Gulati, Lilach O Lerman, Amir Lerman
• Journal: EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology (EuroIntervention) Vol. 17 Issue 7 Pg. 569-575 (Sep 20 2021) ISSN: 1969-6213 [Electronic] France
• PMID: 33342762 (Publication Type: Journal Article)

Topics

• Coronary Artery Disease (diagnostic imaging)
• Fractional Flow Reserve, Myocardial
• Humans
• Hyperemia
• Predictive Value of Tests
• Prognosis
• Risk Factors