Effects of coronary revascularization on global coronary flow reserve in stable coronary artery disease

Tadao Aikawa, Masanao Naya, Masahiko Obara, Osamu Manabe, Keiichi Magota, Kazuhiro Koyanagawa, Naoya Asakawa, Yoichi M. Ito, Tohru Shiga, Chietsugu Katoh, Toshihisa Anzai, Hiroyuki Tsutsui, Venkatesh L. Murthy, Nagara Tamaki

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Aims Coronary flow reserve (CFR) is an integrated measure of the entire coronary vasculature, and is a powerful prognostic marker in coronary artery disease (CAD). The extent to which coronary revascularization can improve CFR is unclear. This study aimed to evaluate the impact of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) on CFR in patients with stable CAD. Methods and results In a prospective, multicentre observational study, CFR was measured by 15 O-water positron emission tomography as the ratio of stress to rest myocardial blood flow at baseline and 6 months after optimal medical therapy (OMT) alone, PCI, or CABG. Changes in the SYNTAX and Leaman scores were angiographically evaluated as indicators of completeness of revascularization. Follow-up was completed by 75 (25 OMT alone, 28 PCI, and 22 CABG) out of 82 patients. The median SYNTAX and Leaman scores, and baseline CFR were 14.5 [interquartile range (IQR): 8-24.5], 5.5 (IQR: 2.5-12.5), and 1.94 (IQR: 1.67-2.66), respectively. Baseline CFR was negatively correlated with the SYNTAX (ρ = -'0.40, P < 0.001) and Leaman scores (ρ = -'0.33, P = 0.004). Overall, only CABG was associated with a significant increase in CFR [1.67 (IQR: 1.14-1.96) vs. 1.98 (IQR: 1.60-2.39), P < 0.001]. Among patients with CFR <2.0 (n = 41), CFR significantly increased in the PCI [1.70 (IQR: 1.42-1.79) vs. 2.21 (IQR: 1.78-2.49), P = 0.002, P < 0.001 for interaction between time and CFR] and CABG groups [1.28 (IQR: 1.13-1.80) vs. 1.86 (IQR: 1.57-2.22), P < 0.001]. The reduction in SYNTAX or Leaman scores after PCI or CABG was independently associated with the percent increase in CFR after adjusting for baseline characteristics (P = 0.012 and P = 0.011, respectively). Conclusion Coronary revascularization ameliorated reduced CFR in patients with obstructive CAD. The degree of improvement in angiographic CAD burden by revascularization was correlated with magnitude of improvement in CFR.

Original languageEnglish
Pages (from-to)119-129
Number of pages11
JournalCardiovascular research
Volume115
Issue number1
DOIs
Publication statusPublished - Jan 1 2019

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Coronary Artery Bypass
Percutaneous Coronary Intervention
Coronary Artery Disease
Positron-Emission Tomography
Multicenter Studies
Observational Studies
Water
Therapeutics

All Science Journal Classification (ASJC) codes

  • Physiology
  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Aikawa, T., Naya, M., Obara, M., Manabe, O., Magota, K., Koyanagawa, K., ... Tamaki, N. (2019). Effects of coronary revascularization on global coronary flow reserve in stable coronary artery disease. Cardiovascular research, 115(1), 119-129. https://doi.org/10.1093/cvr/cvy169

Effects of coronary revascularization on global coronary flow reserve in stable coronary artery disease. / Aikawa, Tadao; Naya, Masanao; Obara, Masahiko; Manabe, Osamu; Magota, Keiichi; Koyanagawa, Kazuhiro; Asakawa, Naoya; Ito, Yoichi M.; Shiga, Tohru; Katoh, Chietsugu; Anzai, Toshihisa; Tsutsui, Hiroyuki; Murthy, Venkatesh L.; Tamaki, Nagara.

In: Cardiovascular research, Vol. 115, No. 1, 01.01.2019, p. 119-129.

Research output: Contribution to journalArticle

Aikawa, T, Naya, M, Obara, M, Manabe, O, Magota, K, Koyanagawa, K, Asakawa, N, Ito, YM, Shiga, T, Katoh, C, Anzai, T, Tsutsui, H, Murthy, VL & Tamaki, N 2019, 'Effects of coronary revascularization on global coronary flow reserve in stable coronary artery disease', Cardiovascular research, vol. 115, no. 1, pp. 119-129. https://doi.org/10.1093/cvr/cvy169
Aikawa, Tadao ; Naya, Masanao ; Obara, Masahiko ; Manabe, Osamu ; Magota, Keiichi ; Koyanagawa, Kazuhiro ; Asakawa, Naoya ; Ito, Yoichi M. ; Shiga, Tohru ; Katoh, Chietsugu ; Anzai, Toshihisa ; Tsutsui, Hiroyuki ; Murthy, Venkatesh L. ; Tamaki, Nagara. / Effects of coronary revascularization on global coronary flow reserve in stable coronary artery disease. In: Cardiovascular research. 2019 ; Vol. 115, No. 1. pp. 119-129.
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abstract = "Aims Coronary flow reserve (CFR) is an integrated measure of the entire coronary vasculature, and is a powerful prognostic marker in coronary artery disease (CAD). The extent to which coronary revascularization can improve CFR is unclear. This study aimed to evaluate the impact of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) on CFR in patients with stable CAD. Methods and results In a prospective, multicentre observational study, CFR was measured by 15 O-water positron emission tomography as the ratio of stress to rest myocardial blood flow at baseline and 6 months after optimal medical therapy (OMT) alone, PCI, or CABG. Changes in the SYNTAX and Leaman scores were angiographically evaluated as indicators of completeness of revascularization. Follow-up was completed by 75 (25 OMT alone, 28 PCI, and 22 CABG) out of 82 patients. The median SYNTAX and Leaman scores, and baseline CFR were 14.5 [interquartile range (IQR): 8-24.5], 5.5 (IQR: 2.5-12.5), and 1.94 (IQR: 1.67-2.66), respectively. Baseline CFR was negatively correlated with the SYNTAX (ρ = -'0.40, P < 0.001) and Leaman scores (ρ = -'0.33, P = 0.004). Overall, only CABG was associated with a significant increase in CFR [1.67 (IQR: 1.14-1.96) vs. 1.98 (IQR: 1.60-2.39), P < 0.001]. Among patients with CFR <2.0 (n = 41), CFR significantly increased in the PCI [1.70 (IQR: 1.42-1.79) vs. 2.21 (IQR: 1.78-2.49), P = 0.002, P < 0.001 for interaction between time and CFR] and CABG groups [1.28 (IQR: 1.13-1.80) vs. 1.86 (IQR: 1.57-2.22), P < 0.001]. The reduction in SYNTAX or Leaman scores after PCI or CABG was independently associated with the percent increase in CFR after adjusting for baseline characteristics (P = 0.012 and P = 0.011, respectively). Conclusion Coronary revascularization ameliorated reduced CFR in patients with obstructive CAD. The degree of improvement in angiographic CAD burden by revascularization was correlated with magnitude of improvement in CFR.",
author = "Tadao Aikawa and Masanao Naya and Masahiko Obara and Osamu Manabe and Keiichi Magota and Kazuhiro Koyanagawa and Naoya Asakawa and Ito, {Yoichi M.} and Tohru Shiga and Chietsugu Katoh and Toshihisa Anzai and Hiroyuki Tsutsui and Murthy, {Venkatesh L.} and Nagara Tamaki",
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T1 - Effects of coronary revascularization on global coronary flow reserve in stable coronary artery disease

AU - Aikawa, Tadao

AU - Naya, Masanao

AU - Obara, Masahiko

AU - Manabe, Osamu

AU - Magota, Keiichi

AU - Koyanagawa, Kazuhiro

AU - Asakawa, Naoya

AU - Ito, Yoichi M.

AU - Shiga, Tohru

AU - Katoh, Chietsugu

AU - Anzai, Toshihisa

AU - Tsutsui, Hiroyuki

AU - Murthy, Venkatesh L.

AU - Tamaki, Nagara

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Aims Coronary flow reserve (CFR) is an integrated measure of the entire coronary vasculature, and is a powerful prognostic marker in coronary artery disease (CAD). The extent to which coronary revascularization can improve CFR is unclear. This study aimed to evaluate the impact of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) on CFR in patients with stable CAD. Methods and results In a prospective, multicentre observational study, CFR was measured by 15 O-water positron emission tomography as the ratio of stress to rest myocardial blood flow at baseline and 6 months after optimal medical therapy (OMT) alone, PCI, or CABG. Changes in the SYNTAX and Leaman scores were angiographically evaluated as indicators of completeness of revascularization. Follow-up was completed by 75 (25 OMT alone, 28 PCI, and 22 CABG) out of 82 patients. The median SYNTAX and Leaman scores, and baseline CFR were 14.5 [interquartile range (IQR): 8-24.5], 5.5 (IQR: 2.5-12.5), and 1.94 (IQR: 1.67-2.66), respectively. Baseline CFR was negatively correlated with the SYNTAX (ρ = -'0.40, P < 0.001) and Leaman scores (ρ = -'0.33, P = 0.004). Overall, only CABG was associated with a significant increase in CFR [1.67 (IQR: 1.14-1.96) vs. 1.98 (IQR: 1.60-2.39), P < 0.001]. Among patients with CFR <2.0 (n = 41), CFR significantly increased in the PCI [1.70 (IQR: 1.42-1.79) vs. 2.21 (IQR: 1.78-2.49), P = 0.002, P < 0.001 for interaction between time and CFR] and CABG groups [1.28 (IQR: 1.13-1.80) vs. 1.86 (IQR: 1.57-2.22), P < 0.001]. The reduction in SYNTAX or Leaman scores after PCI or CABG was independently associated with the percent increase in CFR after adjusting for baseline characteristics (P = 0.012 and P = 0.011, respectively). Conclusion Coronary revascularization ameliorated reduced CFR in patients with obstructive CAD. The degree of improvement in angiographic CAD burden by revascularization was correlated with magnitude of improvement in CFR.

AB - Aims Coronary flow reserve (CFR) is an integrated measure of the entire coronary vasculature, and is a powerful prognostic marker in coronary artery disease (CAD). The extent to which coronary revascularization can improve CFR is unclear. This study aimed to evaluate the impact of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) on CFR in patients with stable CAD. Methods and results In a prospective, multicentre observational study, CFR was measured by 15 O-water positron emission tomography as the ratio of stress to rest myocardial blood flow at baseline and 6 months after optimal medical therapy (OMT) alone, PCI, or CABG. Changes in the SYNTAX and Leaman scores were angiographically evaluated as indicators of completeness of revascularization. Follow-up was completed by 75 (25 OMT alone, 28 PCI, and 22 CABG) out of 82 patients. The median SYNTAX and Leaman scores, and baseline CFR were 14.5 [interquartile range (IQR): 8-24.5], 5.5 (IQR: 2.5-12.5), and 1.94 (IQR: 1.67-2.66), respectively. Baseline CFR was negatively correlated with the SYNTAX (ρ = -'0.40, P < 0.001) and Leaman scores (ρ = -'0.33, P = 0.004). Overall, only CABG was associated with a significant increase in CFR [1.67 (IQR: 1.14-1.96) vs. 1.98 (IQR: 1.60-2.39), P < 0.001]. Among patients with CFR <2.0 (n = 41), CFR significantly increased in the PCI [1.70 (IQR: 1.42-1.79) vs. 2.21 (IQR: 1.78-2.49), P = 0.002, P < 0.001 for interaction between time and CFR] and CABG groups [1.28 (IQR: 1.13-1.80) vs. 1.86 (IQR: 1.57-2.22), P < 0.001]. The reduction in SYNTAX or Leaman scores after PCI or CABG was independently associated with the percent increase in CFR after adjusting for baseline characteristics (P = 0.012 and P = 0.011, respectively). Conclusion Coronary revascularization ameliorated reduced CFR in patients with obstructive CAD. The degree of improvement in angiographic CAD burden by revascularization was correlated with magnitude of improvement in CFR.

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U2 - 10.1093/cvr/cvy169

DO - 10.1093/cvr/cvy169

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