Effects of coronary revascularization on global coronary flow reserve in stable coronary artery disease

• Published in: Cardiovascular research Vol. 115; no. 1; pp. 119 - 129
• Main Authors: Aikawa, Tadao, Naya, Masanao, Obara, Masahiko, Manabe, Osamu, Magota, Keiichi, Koyanagawa, Kazuhiro, Asakawa, Naoya, Ito, Yoichi M, Shiga, Tohru, Katoh, Chietsugu, Anzai, Toshihisa, Tsutsui, Hiroyuki, Murthy, Venkatesh L, Tamaki, Nagara
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.01.2019
• Subjects: Aged; Blood Flow Velocity; Coronary Angiography; Coronary Artery Bypass - adverse effects; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - physiopathology; Coronary Artery Disease - therapy; Coronary Circulation; Coronary Stenosis - diagnostic imaging; Coronary Stenosis - physiopathology; Coronary Stenosis - therapy; Female; Humans; Japan; Male; Middle Aged; Myocardial Perfusion Imaging - methods; Original; Percutaneous Coronary Intervention - adverse effects; Positron Emission Tomography Computed Tomography; Prospective Studies; Recovery of Function; Severity of Illness Index; Time Factors; Treatment Outcome; Japan; O-water positron emission tomography; Coronary flow reserve; Percutaneous coronary intervention; Coronary artery disease; Coronary artery bypass grafting
• ISSN: 0008-6363; 1755-3245
• DOI: 10.1093/cvr/cvy169

Abstract Aims Coronary flow reserve (CFR) is an integrated measure of the entire coronary vasculature, and is a powerful prognostic marker in coronary artery disease (CAD). The extent to which coronary revascularization can improve CFR is unclear. This study aimed to evaluate the impact of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) on CFR in patients with stable CAD. Methods and results In a prospective, multicentre observational study, CFR was measured by 15O-water positron emission tomography as the ratio of stress to rest myocardial blood flow at baseline and 6 months after optimal medical therapy (OMT) alone, PCI, or CABG. Changes in the SYNTAX and Leaman scores were angiographically evaluated as indicators of completeness of revascularization. Follow-up was completed by 75 (25 OMT alone, 28 PCI, and 22 CABG) out of 82 patients. The median SYNTAX and Leaman scores, and baseline CFR were 14.5 [interquartile range (IQR): 8–24.5], 5.5 (IQR: 2.5–12.5), and 1.94 (IQR: 1.67–2.66), respectively. Baseline CFR was negatively correlated with the SYNTAX (ρ = −0.40, P < 0.001) and Leaman scores (ρ = −0.33, P = 0.004). Overall, only CABG was associated with a significant increase in CFR [1.67 (IQR: 1.14–1.96) vs. 1.98 (IQR: 1.60–2.39), P < 0.001]. Among patients with CFR <2.0 (n = 41), CFR significantly increased in the PCI [1.70 (IQR: 1.42–1.79) vs. 2.21 (IQR: 1.78–2.49), P = 0.002, P < 0.001 for interaction between time and CFR] and CABG groups [1.28 (IQR: 1.13–1.80) vs. 1.86 (IQR: 1.57–2.22), P < 0.001]. The reduction in SYNTAX or Leaman scores after PCI or CABG was independently associated with the percent increase in CFR after adjusting for baseline characteristics (P = 0.012 and P = 0.011, respectively). Conclusion Coronary revascularization ameliorated reduced CFR in patients with obstructive CAD. The degree of improvement in angiographic CAD burden by revascularization was correlated with magnitude of improvement in CFR.