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Published on: June 28, 2019
Prognostic Implications of Individual and Combinations of Resting and Hyperemic Coronary Pressure and Flow Parameters
Seokhun Yang1, Doyeon Hwang1, Joo Myung Lee2
1Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Insights
Coronary pressure and flow measurements independently predict adverse outcomes. Combining both resting and hyperemic assessments improves risk prediction for target vessel failure and cardiac events.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Diagnostic Imaging
Background:
- Coronary pressure and flow parameters offer prognostic insights.
- Assessing these parameters aids in revascularization decisions.
Purpose of the Study:
- To evaluate the prognostic significance of individual and combined coronary pressure and flow parameters.
- To assess parameters under both resting and hyperemic conditions.
Main Methods:
- 1,971 vessels deferred from revascularization underwent invasive pressure and flow assessment.
- Abnormal resting/hyperemic pressure and flow were defined using specific thresholds.
- The primary endpoint was target vessel failure, myocardial infarction, or cardiac death at 5 years.
Main Results:
- Abnormal pressure and flow independently predicted target vessel failure and cardiac death/myocardial infarction.
- Risk increased proportionally with the number of abnormal resting or hyperemic parameters.
- Abnormal resting/hyperemic flow added prognostic value to pressure parameters, especially in vessels with normal pressure indices.
Conclusions:
- Abnormal resting and hyperemic pressure and flow are independent prognostic predictors.
- Flow parameters provide additive prognostic value to pressure parameters.
- Resting and hyperemic assessments offer complementary prognostic information.
Background:
Coronary pressure- and flow-derived parameters have prognostic value.
Objectives:
This study aims to investigate the individual and combined prognostic relevance of pressure and flow parameters reflecting resting and hyperemic conditions.
Methods:
A total of 1,971 vessels deferred from revascularization after invasive pressure and flow assessment were included from the international multicenter registry. Abnormal resting pressure and flow were defined as distal coronary pressure/aortic pressure ≤0.92 and high resting flow (1/resting mean transit time >2.4 or resting average peak flow >22.7 cm/s), and abnormal hyperemic pressure and flow as fractional flow reserve ≤0.80 and low hyperemic flow (1/hyperemic mean transit time <2.2 or hyperemic average peak flow <25.0 cm/s), respectively. The clinical endpoint was target vessel failure (TVF), myocardial infarction (MI), or cardiac death at 5 years.
Results:
The mean % diameter stenosis was 46.8% ± 16.5%. Abnormal pressure and flow were independent predictors of TVF and cardiac death/MI (all P < 0.05). The risk of 5-year TVF or MI/cardiac death increased proportionally with neither, either, and both abnormal resting pressure and flow, and abnormal hyperemic pressure and flow (all P for trend < 0.001). Abnormal resting pressure and flow were associated with a higher rate of TVF or MI/cardiac death in vessels with normal fractional flow reserve; this association was similar for abnormal hyperemic pressure and flow in vessels with normal resting distal coronary pressure/aortic pressure (all P < 0.05).
Conclusions:
Abnormal resting and hyperemic pressure and flow were independent prognostic predictors. The abnormal flow had an additive prognostic value for pressure in both resting and hyperemic conditions with complementary prognostic between resting and hyperemic parameters.
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