Robust Association Between Changes in Coronary Flow Capacity Following Percutaneous Coronary Intervention and Vessel-Oriented Outcomes and the Implication for Clinical Practice

Rikuta Hamaya; Taishi Yonetsu; Kodai Sayama; Kazuki Matsuda; Hiroki Ueno; Tatsuhiro Nagamine; Toru Misawa; Masahiro Hada; Masahiro Hoshino; Tomoyo Sugiyama; Tetsuo Sasano; Tsunekazu Kakuta

doi:10.3389/fcvm.2022.901941

Robust Association Between Changes in Coronary Flow Capacity Following Percutaneous Coronary Intervention and Vessel-Oriented Outcomes and the Implication for Clinical Practice

Front Cardiovasc Med. 2022 Jun 15:9:901941. doi: 10.3389/fcvm.2022.901941. eCollection 2022.

Authors

Rikuta Hamaya^{1

2}, Taishi Yonetsu³, Kodai Sayama⁴, Kazuki Matsuda⁴, Hiroki Ueno⁴, Tatsuhiro Nagamine⁴, Toru Misawa⁴, Masahiro Hada³, Masahiro Hoshino⁴, Tomoyo Sugiyama⁴, Tetsuo Sasano³, Tsunekazu Kakuta⁴

Affiliations

¹ Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States.
² Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
³ Department of Cardiology, Tokyo Medical and Dental University, Tokyo, Japan.
⁴ Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan.

Abstract

Background: Coronary flow capacity (CFC) is a potentially important physiologic marker of ischemia for guiding percutaneous coronary intervention (PCI) indication, while the changes through PCI have not been investigated.

Objectives: To assess the determinants and prognostic implication of delta CFC, defined as the change in the CFC status following PCI.

Materials and methods: From a single-center registry, a total of 450 patients with chronic coronary syndrome (CCS) who underwent fractional flow reserve (FFR)-guided PCI with pre-/post-PCI invasive coronary physiological assessments were included. Associations between PCI-related changes in thermodilution method-derived CFC categories and incident target vessel failure (TVF) were assessed.

Results: The mean (SD) age was 67.1 (10.0) years and there were 75 (16.7%) women. Compared with patients showing no change in CFC categories after PCI, patients with category worsened, +1, +2, and +3 category improved had the hazard ratio (95% CI) for incident TVF of 2.27 (0.95, 5.43), 0.85 (0.33, 2.22), 0.45 (0.12, 1.63), and 0.14 (0.016, 1.30), respectively (p for linear trends = 0.0051). After adjustment for confounders, one additional change in CFC status was associated with 0.61 (0.45, 0.83) times the hazard of TVF. CFC changes were largely predicted by the pre-PCI CFC status.

Conclusion: Coronary flow capacity changes following PCI, which was largely determined by the pre-PCI CFC status, were associated with the lower risk of incident TVF in patients with CCS who underwent PCI. The CFC changes provide a mechanistic explanation on potential favorable effect of PCI on reducing vessel-oriented outcome in lesions with reduced CFC and low FFR.

Keywords: coronary artery disease; coronary flow capacity; coronary flow reserve; fractional flow reserve; percutaneous coronary intervention.