The prognostic value of combined intracoronary pressure and blood flow velocity measurements after deferral of percutaneous coronary intervention

Martijn Meuwissen; Steven A J Chamuleau; Maria Siebes; Robbert J de Winter; Karel T Koch; Lea M Dijksman; Anja J van den Berg; Jan G P Tijssen; Jos A E Spaan; Jan J Piek

doi:10.1002/ccd.21331

The prognostic value of combined intracoronary pressure and blood flow velocity measurements after deferral of percutaneous coronary intervention

Martijn Meuwissen, Steven A J Chamuleau, Maria Siebes, Robbert J de Winter, Karel T Koch, Lea M Dijksman, Anja J van den Berg, Jan G P Tijssen, Jos A E Spaan, Jan J Piek

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

OBJECTIVES: We evaluated deferral of PCI of intermediate coronary lesions (IL) using fractional (FFR) and coronary flow reserve (CFR) hyperemic stenosis resistance index (HSR) in patients with a negative or nondiagnostic and noninvasive stress tests.

BACKGROUND: Outcome after deferral of PCI of IL with discordant results between FFR and CFR is unknown.

METHODS: PCI was deferred in 186 IL (mean diameter stenosis: 52%). Patients were divided according to the results of FFR and CFR in group A; FFR >or= 0.75 and CFR >or= 2.0 (n = 129), group B; FFR >or= 0.75 and CFR 2.0 (n = 28), group C; FFR 0.75 and CFR >or= 2.0 (n = 23) and group D; FFR 0.75 and CFR 2.0 (n = 6). Patients were followed for one year to document major adverse cardiac events (MACE).

RESULTS: Nineteen MACEs (0 deaths, 4 myocardial infarctions, 1 CABG, and 14 PCIs) occurred during a follow up of 323 +/- 88 days. MACE rate was lowest (4.7%) when FFR, CFR, and HSR were normal. A higher MACE rate was observed when concordant abnormal (group D) or discordant results between FFR and CFR (group B and C) were compared to concordant normal values (group A, 33.3% vs. 19.7% vs. 5.4%, P = 0.008). Multivariate regression analysis showed a higher predictive power for HSR than for FFR and CFR.

CONCLUSIONS: Abnormal FFR or abnormal CFR was documented in 31% of intermediate coronary lesions. Deferral of PCI in this group was associated with a high MACE rate, which underscores the rationale of combined pressure and flow measurements providing a stenosis resistance index that is better suited for clinical decision making in these lesions.

Original language	English
Pages (from-to)	291-7
Number of pages	7
Journal	Catheterization and Cardiovascular Interventions
Volume	71
Issue number	3
DOIs	https://doi.org/10.1002/ccd.21331
Publication status	Published - 15 Feb 2008

Keywords

Adult
Aged
Aged, 80 and over
Analysis of Variance
Angioplasty, Balloon, Coronary
Blood Flow Velocity
Cardiac Catheterization
Cohort Studies
Coronary Angiography
Coronary Circulation
Coronary Stenosis
Echocardiography, Doppler
Female
Fractional Flow Reserve, Myocardial
Hemodynamics
Humans
Male
Middle Aged
Predictive Value of Tests
Probability
Prognosis
Risk Assessment
Severity of Illness Index
Statistics, Nonparametric
Survival Analysis
Time Factors
Treatment Outcome
Vascular Resistance
Ventricular Pressure

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10.1002/ccd.21331

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Meuwissen, M., Chamuleau, S. A. J., Siebes, M., de Winter, R. J., Koch, K. T., Dijksman, L. M., van den Berg, A. J., Tijssen, J. G. P., Spaan, J. A. E., & Piek, J. J. (2008). The prognostic value of combined intracoronary pressure and blood flow velocity measurements after deferral of percutaneous coronary intervention. Catheterization and Cardiovascular Interventions, 71(3), 291-7. https://doi.org/10.1002/ccd.21331

@article{7fd2964ba6a1478e8ffe296191084c14,

title = "The prognostic value of combined intracoronary pressure and blood flow velocity measurements after deferral of percutaneous coronary intervention",

abstract = "OBJECTIVES: We evaluated deferral of PCI of intermediate coronary lesions (IL) using fractional (FFR) and coronary flow reserve (CFR) hyperemic stenosis resistance index (HSR) in patients with a negative or nondiagnostic and noninvasive stress tests.BACKGROUND: Outcome after deferral of PCI of IL with discordant results between FFR and CFR is unknown.METHODS: PCI was deferred in 186 IL (mean diameter stenosis: 52%). Patients were divided according to the results of FFR and CFR in group A; FFR >or= 0.75 and CFR >or= 2.0 (n = 129), group B; FFR >or= 0.75 and CFR 2.0 (n = 28), group C; FFR 0.75 and CFR >or= 2.0 (n = 23) and group D; FFR 0.75 and CFR 2.0 (n = 6). Patients were followed for one year to document major adverse cardiac events (MACE).RESULTS: Nineteen MACEs (0 deaths, 4 myocardial infarctions, 1 CABG, and 14 PCIs) occurred during a follow up of 323 +/- 88 days. MACE rate was lowest (4.7%) when FFR, CFR, and HSR were normal. A higher MACE rate was observed when concordant abnormal (group D) or discordant results between FFR and CFR (group B and C) were compared to concordant normal values (group A, 33.3% vs. 19.7% vs. 5.4%, P = 0.008). Multivariate regression analysis showed a higher predictive power for HSR than for FFR and CFR.CONCLUSIONS: Abnormal FFR or abnormal CFR was documented in 31% of intermediate coronary lesions. Deferral of PCI in this group was associated with a high MACE rate, which underscores the rationale of combined pressure and flow measurements providing a stenosis resistance index that is better suited for clinical decision making in these lesions.",

keywords = "Adult, Aged, Aged, 80 and over, Analysis of Variance, Angioplasty, Balloon, Coronary, Blood Flow Velocity, Cardiac Catheterization, Cohort Studies, Coronary Angiography, Coronary Circulation, Coronary Stenosis, Echocardiography, Doppler, Female, Fractional Flow Reserve, Myocardial, Hemodynamics, Humans, Male, Middle Aged, Predictive Value of Tests, Probability, Prognosis, Risk Assessment, Severity of Illness Index, Statistics, Nonparametric, Survival Analysis, Time Factors, Treatment Outcome, Vascular Resistance, Ventricular Pressure",

author = "Martijn Meuwissen and Chamuleau, {Steven A J} and Maria Siebes and {de Winter}, {Robbert J} and Koch, {Karel T} and Dijksman, {Lea M} and {van den Berg}, {Anja J} and Tijssen, {Jan G P} and Spaan, {Jos A E} and Piek, {Jan J}",

year = "2008",

month = feb,

day = "15",

doi = "10.1002/ccd.21331",

language = "English",

volume = "71",

pages = "291--7",

journal = "Catheterization and Cardiovascular Interventions",

issn = "1522-1946",

publisher = "Wiley-Liss Inc.",

number = "3",

}

Meuwissen, M, Chamuleau, SAJ, Siebes, M, de Winter, RJ, Koch, KT, Dijksman, LM, van den Berg, AJ, Tijssen, JGP, Spaan, JAE & Piek, JJ 2008, 'The prognostic value of combined intracoronary pressure and blood flow velocity measurements after deferral of percutaneous coronary intervention', Catheterization and Cardiovascular Interventions, vol. 71, no. 3, pp. 291-7. https://doi.org/10.1002/ccd.21331

The prognostic value of combined intracoronary pressure and blood flow velocity measurements after deferral of percutaneous coronary intervention. / Meuwissen, Martijn; Chamuleau, Steven A J; Siebes, Maria et al.
In: Catheterization and Cardiovascular Interventions, Vol. 71, No. 3, 15.02.2008, p. 291-7.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - The prognostic value of combined intracoronary pressure and blood flow velocity measurements after deferral of percutaneous coronary intervention

AU - Meuwissen, Martijn

AU - Chamuleau, Steven A J

AU - Siebes, Maria

AU - de Winter, Robbert J

AU - Koch, Karel T

AU - Dijksman, Lea M

AU - van den Berg, Anja J

AU - Tijssen, Jan G P

AU - Spaan, Jos A E

AU - Piek, Jan J

PY - 2008/2/15

Y1 - 2008/2/15

N2 - OBJECTIVES: We evaluated deferral of PCI of intermediate coronary lesions (IL) using fractional (FFR) and coronary flow reserve (CFR) hyperemic stenosis resistance index (HSR) in patients with a negative or nondiagnostic and noninvasive stress tests.BACKGROUND: Outcome after deferral of PCI of IL with discordant results between FFR and CFR is unknown.METHODS: PCI was deferred in 186 IL (mean diameter stenosis: 52%). Patients were divided according to the results of FFR and CFR in group A; FFR >or= 0.75 and CFR >or= 2.0 (n = 129), group B; FFR >or= 0.75 and CFR 2.0 (n = 28), group C; FFR 0.75 and CFR >or= 2.0 (n = 23) and group D; FFR 0.75 and CFR 2.0 (n = 6). Patients were followed for one year to document major adverse cardiac events (MACE).RESULTS: Nineteen MACEs (0 deaths, 4 myocardial infarctions, 1 CABG, and 14 PCIs) occurred during a follow up of 323 +/- 88 days. MACE rate was lowest (4.7%) when FFR, CFR, and HSR were normal. A higher MACE rate was observed when concordant abnormal (group D) or discordant results between FFR and CFR (group B and C) were compared to concordant normal values (group A, 33.3% vs. 19.7% vs. 5.4%, P = 0.008). Multivariate regression analysis showed a higher predictive power for HSR than for FFR and CFR.CONCLUSIONS: Abnormal FFR or abnormal CFR was documented in 31% of intermediate coronary lesions. Deferral of PCI in this group was associated with a high MACE rate, which underscores the rationale of combined pressure and flow measurements providing a stenosis resistance index that is better suited for clinical decision making in these lesions.

AB - OBJECTIVES: We evaluated deferral of PCI of intermediate coronary lesions (IL) using fractional (FFR) and coronary flow reserve (CFR) hyperemic stenosis resistance index (HSR) in patients with a negative or nondiagnostic and noninvasive stress tests.BACKGROUND: Outcome after deferral of PCI of IL with discordant results between FFR and CFR is unknown.METHODS: PCI was deferred in 186 IL (mean diameter stenosis: 52%). Patients were divided according to the results of FFR and CFR in group A; FFR >or= 0.75 and CFR >or= 2.0 (n = 129), group B; FFR >or= 0.75 and CFR 2.0 (n = 28), group C; FFR 0.75 and CFR >or= 2.0 (n = 23) and group D; FFR 0.75 and CFR 2.0 (n = 6). Patients were followed for one year to document major adverse cardiac events (MACE).RESULTS: Nineteen MACEs (0 deaths, 4 myocardial infarctions, 1 CABG, and 14 PCIs) occurred during a follow up of 323 +/- 88 days. MACE rate was lowest (4.7%) when FFR, CFR, and HSR were normal. A higher MACE rate was observed when concordant abnormal (group D) or discordant results between FFR and CFR (group B and C) were compared to concordant normal values (group A, 33.3% vs. 19.7% vs. 5.4%, P = 0.008). Multivariate regression analysis showed a higher predictive power for HSR than for FFR and CFR.CONCLUSIONS: Abnormal FFR or abnormal CFR was documented in 31% of intermediate coronary lesions. Deferral of PCI in this group was associated with a high MACE rate, which underscores the rationale of combined pressure and flow measurements providing a stenosis resistance index that is better suited for clinical decision making in these lesions.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Analysis of Variance

KW - Angioplasty, Balloon, Coronary

KW - Blood Flow Velocity

KW - Cardiac Catheterization

KW - Cohort Studies

KW - Coronary Angiography

KW - Coronary Circulation

KW - Coronary Stenosis

KW - Echocardiography, Doppler

KW - Female

KW - Fractional Flow Reserve, Myocardial

KW - Hemodynamics

KW - Humans

KW - Male

KW - Middle Aged

KW - Predictive Value of Tests

KW - Probability

KW - Prognosis

KW - Risk Assessment

KW - Severity of Illness Index

KW - Statistics, Nonparametric

KW - Survival Analysis

KW - Time Factors

KW - Treatment Outcome

KW - Vascular Resistance

KW - Ventricular Pressure

U2 - 10.1002/ccd.21331

DO - 10.1002/ccd.21331

M3 - Article

C2 - 18288725

SN - 1522-1946

VL - 71

SP - 291

EP - 297

JO - Catheterization and Cardiovascular Interventions

JF - Catheterization and Cardiovascular Interventions

IS - 3

ER -

The prognostic value of combined intracoronary pressure and blood flow velocity measurements after deferral of percutaneous coronary intervention

Abstract

Keywords

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