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

Prognostic Value of Thermodilution-derived Coronary Flow Capacity in Patients with Deferred Revascularization

DOI: 10.4244/EIJ-D-19-00029

1. Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
2. Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
3. Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
4. Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
5. Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
6. Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
7. Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
8. Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
9. Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
10. Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
11. Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
12. Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan, JAPAN
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Aims: To investigate the prognostic value of thermodilution-derived coronary flow capacity (T-CFC) in patients with stable coronary artery disease and deferred revascularization.

Methods and results: We evaluated 308 lesions in 308 patients with deferred revascularization, stratifying the cohort according to T-CFC. Ischemic T-CFC was defined as a composite of mildly-, moderately-, and severely-reduced T-CFC. Clinical outcomes were assessed by vessel-oriented composite endpoints (VOCE) and major adverse cardiac events (MACE). VOCE and MACE occurred in 19 and 28 patients, respectively. Ischemic T-CFC was found in 88 lesions (28.6%). Kaplan–Meier analysis revealed that lesions with ischemic T-CFC had a significantly higher risk of both VOCE and MACE. Net reclassification index and integrated discrimination improvement index were both significantly improved when ischemic T-CFC was added to the clinical risk model (age, sex, prior stent implantation, and lesion length) for predicting VOCE and MACE. Furthermore, ischemic T-CFC showed significant incremental predictive ability for VOCE and MACE when compared with the clinical risk model + fractional flow reserve ≤ 0.8, or with the clinical model + coronary flow reserve ≤ 2.0.

Conclusions: T-CFC categorization improved the risk stratification for both VOCE and MACE and showed incremental prognostic value in patients with deferred revascularization.

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