Changes in absolute coronary blood flow and myocardial resistance after percutaneous coronary intervention

Abstract

Background: Treating a coronary stenosis by percutaneous coronary intervention (PCI) aims to relieve myocardial ischaemia by improving coronary blood flow. The evolution of coronary flow and resistance post-PCI is not fully understood.

Aims: This study aimed to investigate the immediate impact of PCI on absolute coronary flow (Q), and epicardial and microvascular resistance (R_epi and R_μ).

Methods: In a two-centre cohort including 52 patients, pre- and post-PCI physiological assessments were performed using continuous thermodilution, via a combination of a pressure-temperature sensor wire and a dedicated infusion microcatheter.

Results: Resting Q remained similar before and after PCI (Δ +2 [interquartile range [IQR] −9 to 21] mL/min; p=0.21), as a 193 Wood unit (WU) reduction in resting R_epi (Δ −193 [IQR −400 to −59] WU; p<0.001) was offset by a 267 WU increase in resting R_μ (Δ +267 [IQR −20 to 474] WU; p=0.002). Conversely, hyperaemic Q rose significantly (Δ +44 [IQR 16 to 92] mL/min; p<0.001), reflecting a 195 WU reduction in hyperaemic R_epi (Δ −195 [IQR −379 to −82] WU; p<0.001), while hyperaemic R_μ remained stable (Δ +3 [IQR −96 to 75] WU; p=0.87). The median microvascular resistance reserve (MRR) did not change significantly after PCI (Δ −0.2 [IQR −0.7 to 0.6]; p=0.301). Pre- and post-PCI fractional flow reserve (FFR) were strongly and inversely associated with R_epi and predicted the improvement of hyperaemic Q.

Conclusions: PCI significantly reduces epicardial resistance, leading to a pronounced increase in hyperaemic flow, which can be predicted by FFR. Resting Q remained unchanged because of compensatory increases in microvascular resistance, providing direct evidence of coronary flow autoregulation in humans. The MRR was unaffected by PCI, confirming its specificity as an index of microvascular function.