Prognostic Implications of Individual and Combinations of Resting and Hyperemic Coronary Pressure and Flow Parameters

Seokhun Yang, Doyeon Hwang, Joo Myung Lee, Seung Hun Lee, Coen K. M. Boerhout, Janneke Woudstra, Caitlin E. M. Vink, Guus A. de Waard, Ji Hyun Jung, Hernan Mejia Renteria, Masahiro Hoshino, Mauro Echavarria Pinto, Martijn Meuwissen, Hitoshi Matsuo, Maribel Madera Cambero, Ashkan Eftekhari, Mohamed A. Effat, Tadashi Murai, Koen Marques, Yolande AppelmanJoon Hyung Doh, Evald H. Christiansen, Rupak Banerjee, Hyun Kuk Kim, Chang Wook Nam, Giampaolo Niccoli, Masafumi Nakayama, Nobuhiro Tanaka, Eun Seok Shin, Marcel A. M. Beijk, Steven A. J. Chamuleau, Niels van Royen, Paul Knaapen, Tsunekazu Kakuta, Javier Escaned, Jan J. Piek, Tim P. van de Hoef, Bon-Kwon Koo

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)865-877
Number of pages13
JournalJACC: Asia
Volume3
Issue number6
Early online date2023
DOIs
Publication statusPublished - Dec 2023

Keywords

  • coronary blood flow
  • coronary flow reserve
  • fractional flow reserve
  • ischemia

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