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CLINICAL STUDIES

Safety of deferring angioplasty in patients with normal coronary flow velocity reserve

^a Clinic of Internal Medicine III (Cardiology & Angiology & Intensive Care Medicine) Friedrich-Schiller-Universität, Jena, Germany
^* Clinic of Internal Medicine (Cardiology & Pulmonology) Georg-August-Universität, Göttingen, Germany

Manuscript received May 11, 1998; revised manuscript received August 19, 1998, accepted September 24, 1998.

Address for correspondence: Dr. H. R. Figulla, Klinik für Innere Medizin III, Friedrich-Schiller-Universität, Erlanger Allee 101, D-07740 Jena, Germany
figulla{at}polkim.med.uni-jena.de

Background. In the catheter laboratory there is a need for functional tests validating the hemodynamic significance of coronary artery stenosis.

Objectives. It was the objective of our study to compare the long-term cardiac event rate and the clinical symptoms in patients with reduced coronary flow velocity reserve (CFVR) and standard PTCA with patients with normal CFVR and deferred angioplasty.

Methods. Our study included 70 patients with intermediate coronary artery stenoses (13 f, 57 m; diameter stenosis >50%, <90%) and an indication for PTCA due to stable angina pectoris and/or signs of ischemia in noninvasive stress tests. CFVR was measured distal to the lesion after intracoronary administration of adenosine using 0.014 inch Doppler-tipped guide wires.

Results. In 22 patients (31%), PTCA was deferred due to a CFVR 2.0 (non-PTCA group). In the remaining 48 patients (69%) mean CFVR of 1.4 ± 0.23 (p < 0.001) was measured (PTCA group). CFVR increased to 2.0 ± 0.51 after angioplasty. During follow-up (average 15 ± 6.0 months), the following major adverse cardiac events (MACE) occurred: in the PTCA group re-PTCA was performed in nine patients (18.8%) because of unstable angina, five patients (10.4%) suffered an acute myocardial infarction (MI) (two infarctions occurred during the angioplasty, three patients suffered an infarction during follow-up), two patients (4.2%) needed blood transfusions due to severe bleedings, two patients (4.2%) underwent bypass surgery and one patient (2.1%) died. In the non-PTCA group, angioplasty was necessary only in two cases (9.1%) during follow-up. We did not observe any MI in the non-PTCA group.

The overall rate of MACE was significantly lower in the non-PTCA group compared to the PTCA group (9.1% vs. 33.3%, p < 0.01). However, only 40% of the patients of the non-PTCA group were free of angina pectoris at stress. In the PTCA group, 63% did not complain of any symptoms at follow-up (p < 0.05).

Conclusions. We conclude that determination of the CFVR is a valuable parameter for stratifying the hemodynamic significance of coronary artery stenosis. PTCA can safely be deferred in patients with significant coronary stenosis but a CFVR 2.0. The total rate of MACE at follow-up was below 10% among these patients. However, if PTCA was deferred the number of patients who are free of angina is lower compared to those patients who underwent angioplasty.

Abbreviations and Acronyms   APV = average peak velocity   CABG = coronary artery bypass graft surgery   CAD = coronary artery disease   CCS = Canadian Cardiological Society   CFVR = coronary flow velocity reserve   FFR = fractional flow reserve   MACE = major adverse cardiac event   MI = myocardial infarction   NYHA = New York Heart Association   PTCA = percutaneous transluminal coronary angioplasty   QCA = quantitative coronary angiography   RFVR = relative coronary flow velocity reserve   SPECT = single-photon emission computed tomography

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