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Elevated Resting Coronary Blood Flow Is Associated With Death, MI, and HF in All-Comer Patients With Chronic Coronary
Shajan Shekarestan1, Fadi Jokhaji1, Christina Ekenbäck1
1Division of Cardiovascular Medicine (S.S., F.J., C.E., M.T., P.L., N.O.-P., R.L., B.S., J.P.), Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
Insights
Elevated resting coronary blood flow (CBF) in patients with chronic coronary syndrome is linked to adverse cardiovascular events. However, hyperemic microcirculatory resistance and flow did not show a significant association with outcomes in this study.
Area of Science:
- Cardiology
- Vascular Biology
- Diagnostic Imaging
Background:
- Prognostic value of resting coronary blood flow (CBF) in chronic coronary syndrome (CCS) using thermodilution is unknown.
- Investigated association of thermodilution-derived coronary flow indices with clinical outcomes in CCS patients.
Purpose of the Study:
- To determine the prognostic implications of resting coronary blood flow (CBF) derived from bolus thermodilution in all-comer patients with chronic coronary syndrome.
- To assess the association of various thermodilution-derived indices of coronary flow with major adverse cardiovascular events.
Main Methods:
- Prospective observational study including 410 patients with CCS, with or without obstructive coronary artery disease.
- Thermodilution measurements of index of microcirculatory resistance, baseline resistance index, resting CBF, and hyperemic CBF in the left anterior descending coronary artery.
- Cox-regression and Kaplan-Meier analyses evaluated the association between flow indices and a composite outcome of all-cause mortality, nonfatal myocardial infarction, or heart failure hospitalization.
Main Results:
- Resting coronary blood flow (CBF) was independently associated with the primary composite outcome (HR, 1.23; 95% CI, 1.02-1.48).
- This association was significant in patients undergoing revascularization (HR, 1.30; 95% CI, 1.04-1.64) but not in those not undergoing revascularization.
- Neither index of microcirculatory resistance nor hyperemic CBF showed association with outcomes. Functional coronary microvascular dysfunction correlated with higher adverse events (log-rank P=0.041).
Conclusions:
- Elevated resting coronary blood flow (CBF) in the left anterior descending coronary artery is associated with major adverse cardiovascular events in chronic coronary syndrome.
- Hyperemic microcirculatory resistance and flow were not associated with adverse outcomes.
- Functional coronary microvascular dysfunction predicts poorer prognosis in CCS patients.
Background:
The prognostic implications of bolus thermodilution-derived resting coronary blood flow in all-comer patients with chronic coronary syndrome are not known. We investigated the association of thermodilution-derived indices characterizing coronary flow with outcomes.
Methods:
Patients with chronic coronary syndrome with and without obstructive coronary artery disease were included before undergoing coronary angiography in this prospective observational study. Measurements of the index of microcirculatory resistance, baseline resistance index, resting coronary blood flow (CBF), and hyperemic CBF were obtained with thermodilution in the left anterior descending coronary artery. Cox-regression analyses adjusted for age, sex, number of diseased vessels, and estimated creatinine clearance, as well as Kaplan-Meier plots, were used to evaluate the relation between flow indices and the primary composite outcome of all-cause mortality, nonfatal myocardial infarction, or heart failure hospitalization.
Results:
Analyses included 410 patients with 55 events. Median follow-up was 5.4 years. Resting CBF was independently associated with the primary outcome (hazard ratio, 1.23 [95% CI 1.02-1.48]). Resting CBF was associated with the primary outcome in patients undergoing revascularization (hazard ratio, 1.30 [95% CI 1.04-1.64]) but not in patients not undergoing revascularization (hazard ratio, 1.15 [95% 0.82-1.60]; P interaction=0.771). Neither the index of microcirculatory resistance nor hyperemic CBF were associated with outcomes. Functional coronary microvascular dysfunction was associated with a higher incidence of death and nonfatal myocardial infarction versus no coronary microvascular dysfunction (log-rank P=0.041), whereas structural coronary microvascular dysfunction was not.
Conclusions:
Elevated resting CBF in the left anterior descending coronary artery was associated with major adverse cardiovascular events in chronic coronary syndrome, whereas hyperemic microcirculatory resistance and flow were not.
Registration:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT06306066.
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