The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Prognostic Impact and Clinical Outcomes of Coronary Flow Reserve and Hyperemic Microvascular Resistance

DOI: 10.4244/EIJ-D-20-00853

1. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
2. Division of Cardiology, National Defense Medical College, Tokorozawa, Saitama, Japan
3. Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA



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Aims: We aimed to investigate whether coronary flow reserve (CFR) and hyperemic microvascular resistance (HMR) as continua predict major adverse cardiovascular events (MACE), comprising all-cause death, myocardial infarction, revascularization, and stroke in patients with ischemia and no obstructive coronary artery disease.

Methods and Results: A total of 610 patients were included and followed-up over a median of 8.0 years (199 individual MACE in 174 patients). Both CFR and HMR as continua predicted MACE with an odds ratio (OR) of 0.70 (per 1 unit increase, 95% confidence interval [CI] [0.53, 0.92], P = 0.01) and 1.63 (per 1 mm Hg/cm/s, 95% CI [1.20, 2.21], P = 0.002), respectively. This relationship remained significant after adjustment for age and sex with an adjusted OR of 0.66 (per 1 unit increase, 95% CI [0.49, 0.89], P = 0.01) and 1.42 (per 1 mm Hg/cm/s, 95% CI [1.03, 1.94], P = 0.03). HMR added prognostic value to CFR in predicting MACE (net reclassification index 0.17, 95% CI [0.02, 0.31], P = 0.03; integrated discrimination improvement 0.01, 95% CI [0.0001, 0.02], P = 0.046).

Conclusions: Both CFR and HMR as continuous variables predict future risk of MACE.

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