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European Heart Journal 2002 23(4):331-340; doi:10.1053/euhj.2001.2734
Copyright © 2002 by the European Society of Cardiology.
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Impact of final coronary flow velocity reserve on late outcome following stent implantation

T. Nishidaa, C. Di Marioa,f1, M.J. Kernb, T.J. Andersonc, I. Moussad, R. Bonane, T. Muramatsuf, A.C. Jaing, J. Suarez de Lezoh, S.Y. Choi, I.T. Meredithj, J.W. Mosesd and A. Colomboa

a Centro Cuore Columbus, Milan, Italy
b Saint Louis University Health Sciences Center, St. Louis, MO, U.S.A.
c Foothills Hospital, University of Calgary, Calgary, Alberta, Canada
d Lenox Hill Hospital, New York, NY, U.S.A.
e Institut de Cardiologie de Montreal, Montreal, Canada
f Social Insurance Kawasaki Hospital, Kawasaki, Kanagawa, Japan
g West Virginia University School of Medicine, Robert C. Byrd Health Sciences Center, Morgantown, WV, U.S.A.
h Hospital Reina Sofia, University of Cordoba, Spain
i Yonsei University College of Medicine, Seoul, South Korea
j Monash Medical Centre and Monash University, Department of Medicine, Clayton, Vic. Australia

revised April 9, 2001; accepted April 11, 2001

Abstract

Aims To assess whether coronary flow velocity reserve following stent implantation is predictive of the subsequent need of target lesion revascularization.

Methods and Results The outcome was examined of 417 patients enrolled in a multicentre prospective randomized study (DESTINI), who received a successful single vessel stent implantation in native coronary arteries and in whom coronary flow velocity reserve was measured. Logistic regression analysis and the receiver operator characteristic curve were used. When compared with 358 patients not requiring target lesion revascularization, 59 patients (14%) who underwent target lesion revascularization had a lower final coronary flow velocity reserve (2·33±0·87 vs 2·48± 0·80, P=0·20) and smaller final minimal lumen diameter (2·62±0·66mm vs 2·73±0·60,P =0·19); however, those differences were not statistically significant. Patients with a coronary flow velocity reserve of <2·0 (n=109, 26%) exhibited a significantly higher target lesion revascularization rate than patients with a coronary flow velocity reserve of ≥2·0 (22% vs 11%, P=0·010). This difference remained significant (odds ratio=2·01, 95% CI=1·11 to 3·66) after adjustment for other variables that were also correlated with the incidence of target lesion revascularization.

Conclusion The presence of a final coronary flow velocity reserve of <2·0 is an independent predictor of the need for target lesion revascularization after stent implantation in native coronary artery lesions.

Key Words: Intracoronary Doppler, stent, coronary flow velocity reserve

f1 Correspondence: Carlo Di Mario, MD, PhD, EMO Centro Cuore Columbus, Columbus Clinic and Catheterization Laboratory 'San Raffaele Hospital', Via Buonarroti 48, 20145, Milan, Italy.

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