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Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
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Chronologic evolution and prognostic implications of impaired coronary flow after chronic total occlusion angioplasty

You Zhou1,2,3, Jiaqi Ma1,2,3, Zhangwei Chen1,2,3

  • 1Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.

Cardiovascular Diagnosis and Therapy
|November 9, 2023
PubMed

Insights

Slow flow (SF) after chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is linked to worse outcomes, including periprocedural myocardial infarction and restenosis. Achieving normal coronary flow is crucial for successful CTO revascularization and improved patient prognosis.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Biology

Background:

  • Successful recanalization of chronic total occlusion (CTO) vessels can lead to recovery, but the clinical significance of slow flow (SF) phenomenon post-recanalization remains understudied.
  • Limited evidence exists regarding the determinants, development, and prognostic impact of SF following percutaneous coronary intervention (PCI) for CTO.

Purpose of the Study:

  • To evaluate the clinical significance of the slow flow (SF) phenomenon after successful recanalization of chronic total occlusion (CTO) via percutaneous coronary intervention (PCI).
  • To identify the independent predictors and prognostic impact of SF on clinical outcomes and target lesion restenosis in patients undergoing CTO PCI.

Main Methods:

  • Retrospective cohort study of 500 patients undergoing CTO PCI with follow-up angiography.
  • Coronary flow assessed using corrected Thrombolysis in Myocardial Infarction (TIMI) frame count (CTFC).
  • Analysis of clinical, angiographic, and procedural characteristics to determine SF predictors and outcomes.

Main Results:

  • Slow flow (SF) was observed in 5.8% of patients post-CTO PCI.
  • Independent predictors of SF included prior myocardial infarction, right coronary artery (RCA) revascularization, and lack of bilateral collaterals.
  • SF was associated with increased risks of periprocedural myocardial infarction (PMI) and target lesion restenosis.
  • In patients with baseline LVEF ≤60%, systolic improvement was compromised in the SF group compared to the normal flow group.

Conclusions:

  • The slow flow (SF) phenomenon significantly influences the prognosis of patients undergoing CTO PCI.
  • Achieving normal coronary flow during CTO revascularization is essential for optimal patient outcomes.
  • Further research into managing SF post-CTO PCI may improve long-term results.
Abstract

Keywords:
Chronic total occlusion (CTO)percutaneous coronary intervention (PCI)prognosisslow flow (SF)

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