Coronary flow capacity and survival prediction after revascularization: physiological basis and clinical implications

K. Lance Gould, Nils P. Johnson, Amanda E. Roby, Linh Bui, Danai Kitkungvan, Monica B. Patel, Tung Nguyen, Richard Kirkeeide, Mary Haynie, Salman A. Arain, Konstantinos Charitakis, Abhijeet Dhoble, Richard Smalling, Angelo Nascimbene, Marwan Jumean, Sachin Kumar, Biswajit Kar, Stefano Sdringola, Anthony Estrera, Igor GregoricDejian Lai, Ruosha Li, David McPherson, Jagat Narula

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Background and Coronary flow capacity (CFC) is associated with an observed 10-year survival probability for individual patients before and Aims after actual revascularization for comparison to virtual hypothetical ideal complete revascularization. Methods Stress myocardial perfusion (mL/min/g) and coronary flow reserve (CFR) per pixel were quantified in 6979 coronary artery disease (CAD) subjects using Rb-82 positron emission tomography (PET) for CFC maps of artery-specific size-severity abnormalities expressed as percent left ventricle with prospective follow-up to define survival probability per-decade as fraction of 1.0. Results Severely reduced CFC in 6979 subjects predicted low survival probability that improved by 42% after revascularization compared with no revascularization for comparable severity (P = .0015). For 283 pre-and-post-procedure PET pairs, severely reduced regional CFC-associated survival probability improved heterogeneously after revascularization (P < .001), more so after bypass surgery than percutaneous coronary interventions (P < .001) but normalized in only 5.7%; non-severe baseline CFC or survival probability did not improve compared with severe CFC (P = .00001). Observed CFC-associated survival probability after actual revascularization was lower than virtual ideal hypothetical complete post-revascularization survival probability due to residual CAD or failed revascularization (P < .001) unrelated to gender or microvascular dysfunction. Severely reduced CFC in 2552 post-revascularization subjects associated with low survival probability also improved after repeat revascularization compared with no repeat procedures (P = .025). Conclusions Severely reduced CFC and associated observed survival probability improved after first and repeat revascularization compared with no revascularization for comparable CFC severity. Non-severe CFC showed no benefit. Discordance between observed actual and virtual hypothetical post-revascularization survival probability revealed residual CAD or failed revascularization.

Original languageEnglish (US)
Pages (from-to)181-194
Number of pages14
JournalEuropean Heart Journal
Volume45
Issue number3
DOIs
StatePublished - Jan 14 2024
Externally publishedYes

Keywords

  • Coronary artery disease
  • Coronary bypass surgery
  • Coronary flow reserve
  • Myocardial ischaemia
  • Myocardial perfusion
  • PET imaging

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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