Coronary Flow Capacity and Survival Prediction after Revascularization: Physiological Basis and Clinical Implications

Authors

K Lance Gould
Nils P Johnson
Amanda E Roby
Linh Bui
Danai Kitkungvan
Monica B Patel
Tung Nguyen
Richard Kirkeeide
Mary Haynie
Salman A Arain
Konstantinos Charitakis
Abhijeet Dhoble
Richard Smalling
Angelo Nascimbene
Marwan Jumean
Sachin Kumar
Biswajit Kar
Stefano Sdringola
Anthony Estrera
Igor Gregoric
Dejian Lai
Ruosha Li
David McPherson
Jagat Narula

Publication Date

1-14-2024

Journal

European Heart Journal

Abstract

BACKGROUND AND AIMS: Coronary flow capacity (CFC) is associated with an observed 10-year survival probability for individual patients before and after actual revascularization for comparison to virtual hypothetical ideal complete revascularization.

METHODS: Stress myocardial perfusion (mL/min/g) and coronary flow reserve (CFR) per pixel were quantified in 6979 coronary artery disease (CAD) subjects using Rb-82 positron emission tomography (PET) for CFC maps of artery-specific size-severity abnormalities expressed as percent left ventricle with prospective follow-up to define survival probability per-decade as fraction of 1.0.

RESULTS: Severely reduced CFC in 6979 subjects predicted low survival probability that improved by 42% after revascularization compared with no revascularization for comparable severity (P = .0015). For 283 pre-and-post-procedure PET pairs, severely reduced regional CFC-associated survival probability improved heterogeneously after revascularization (P < .001), more so after bypass surgery than percutaneous coronary interventions (P < .001) but normalized in only 5.7%; non-severe baseline CFC or survival probability did not improve compared with severe CFC (P = .00001). Observed CFC-associated survival probability after actual revascularization was lower than virtual ideal hypothetical complete post-revascularization survival probability due to residual CAD or failed revascularization (P < .001) unrelated to gender or microvascular dysfunction. Severely reduced CFC in 2552 post-revascularization subjects associated with low survival probability also improved after repeat revascularization compared with no repeat procedures (P = .025).

CONCLUSIONS: Severely reduced CFC and associated observed survival probability improved after first and repeat revascularization compared with no revascularization for comparable CFC severity. Non-severe CFC showed no benefit. Discordance between observed actual and virtual hypothetical post-revascularization survival probability revealed residual CAD or failed revascularization.

Keywords

Humans, Rubidium Radioisotopes, Prospective Studies, Coronary Artery Disease, Positron-Emission tomography, Coronary Angiography