This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Voskuil, M. Search for Related Content PubMed PubMed Citation Articles by Voskuil, M.

CLINICAL STUDY: INTERVENTIONAL CARDIOLOGY

Coronary hemodynamics of stent implantation after suboptimal and optimal balloon angioplasty

Michiel Voskuil, MD^*, Rob A. M. van Liebergen, MD^*, Mariano Albertal, MD, Eric Boersma, PhD, Jan G. P. Tijssen, PhD^*, Patrick W. Serruys, MD, Jan J. Piek, MD^*,* the DEBATE II Investigators

^* Academic Medical Center, Amsterdam, The Netherlands
Thoraxcenter, Rotterdam, The Netherlands

^* Reprint requests and correspondence: Dr. Jan J. Piek, Department of Cardiology, B2-108, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
j.j.piek{at}amc.uva.nl

OBJECTIVES: This study was performed to evaluate hemodynamic alterations of stent implantation after Doppler flow–guided balloon angioplasty (BA).

BACKGROUND: There is controversy regarding the effect of stent implantation on coronary hemodynamics after suboptimal and optimal BA.

METHODS: A total of 523 of 620 patients underwent Doppler-guided BA in the setting of a multicenter study and were analyzed before and after additional stent implantation. Balloon angioplasty was considered optimal when the diameter stenosis (DS) was 35% and coronary flow reserve (CFR) was >2.5 and suboptimal if these two criteria were not met. Coronary flow reserve was also measured in an angiographically normal artery to determine relative CFR. Patients were followed for 12 months to document major adverse cardiac events (MACE).

RESULTS: The main difference between patients with suboptimal BA (n = 195 [51%]) and optimal BA (n = 184 [49%]) was a more pronounced increase in baseline blood flow velocity (15 ± 8 to 22 ± 11 vs. 14 ± 8 to 16 ± 10 cm/s, p < 0.01). Coronary flow reserve improved after stent implantation in both patient groups, owing to a reduction in residual lumen obstruction, as determined by angiographic (%DS) and Doppler flow criteria (hyperemic blood flow velocity, relative CFR), and was associated with a decrease in MACE (16% vs. 7% in optimal BA group, p = 0.08; and 27% vs. 11% in suboptimal BA group, p = 0.007).

CONCLUSIONS: Stent implantation enhances CFR after suboptimal and optimal Doppler-guided BA, owing to a reduction in residual lumen obstruction—determined by angiographical and Doppler flow criteria—as the underlying mechanism for an improved clinical outcome.

Abbreviations and Acronyms   BA   balloon angioplasty   CFR   coronary flow reserve   DEBATE   Doppler Endpoints Balloon Angioplasty Trial Europe   DS   diameter stenosis   MACE   major adverse cardiac events   OR   odds ratio   PTCA   percutaneous transluminal coronary angioplasty

This article has been cited by other articles:

				H. J. Verberne, M. Meuwissen, S. A. J. Chamuleau, B.-J. Verhoeff, B. L. F. van Eck-Smit, J. A. E. Spaan, J. J. Piek, and M. Siebes Effect of simultaneous intracoronary guidewires on the predictive accuracy of functional parameters of coronary lesion severity Am J Physiol Heart Circ Physiol, May 1, 2007; 292(5): H2349 - H2355. [Abstract] [Full Text] [PDF]

				M. J. Kern, A. Lerman, J.-W. Bech, B. De Bruyne, E. Eeckhout, W. F. Fearon, S. T. Higano, M. J. Lim, M. Meuwissen, J. J. Piek, et al. Physiological Assessment of Coronary Artery Disease in the Cardiac Catheterization Laboratory: A Scientific Statement From the American Heart Association Committee on Diagnostic and Interventional Cardiac Catheterization, Council on Clinical Cardiology Circulation, September 19, 2006; 114(12): 1321 - 1341. [Abstract] [Full Text] [PDF]

				M. Siebes, B.-J. Verhoeff, M. Meuwissen, R. J. de Winter, J. A.E. Spaan, and J. J. Piek Single-Wire Pressure and Flow Velocity Measurement to Quantify Coronary Stenosis Hemodynamics and Effects of Percutaneous Interventions Circulation, February 17, 2004; 109(6): 756 - 762. [Abstract] [Full Text] [PDF]

				D. A. Cox, G. W. Stone, C. L. Grines, T. Stuckey, D. J. Cohen, J. E. Tcheng, E. Garcia, G. Guagliumi, R. S. Iwaoka, M. Fahy, et al. Outcomes of optimal or "stent-like"balloon angioplasty in acutemyocardial infarction: the CADILLAC trial J. Am. Coll. Cardiol., September 17, 2003; 42(6): 971 - 977. [Abstract] [Full Text] [PDF]