TY - JOUR
T1 - Prognostic impact and clinical outcomes of coronary flow reserve and hyperaemic microvascular resistance
AU - Toya, Takumi
AU - Corban, Michel T.
AU - Park, Ji Young
AU - Ahmad, Ali
AU - Özcan, Ilke
AU - Sebaali, Faten
AU - Sara, Jaskanwal D.
AU - Gulati, Rajiv
AU - Lerman, Lilach O.
AU - Lerman, Amir
N1 - Publisher Copyright:
© Europa Digital & Publishing 2021. All rights reserved.
PY - 2021/9
Y1 - 2021/9
N2 - Background: Most studies dichotomise indices of coronary microvascular function to assess their prognostic values. Aims: We aimed to investigate whether coronary flow reserve (CFR) and hyperaemic microvascular resistance (HMR) as continua predict major adverse cardiovascular events (MACE), comprising all-cause death, myocardial infarction, revascularisation, and stroke in patients with ischaemia and non-obstructive coronary artery disease. Methods: A total of 610 patients were included and followed up over a median of 8.0 years (199 individual MACE in 174 patients). Results: 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 mmHg/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 mmHg/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.
AB - Background: Most studies dichotomise indices of coronary microvascular function to assess their prognostic values. Aims: We aimed to investigate whether coronary flow reserve (CFR) and hyperaemic microvascular resistance (HMR) as continua predict major adverse cardiovascular events (MACE), comprising all-cause death, myocardial infarction, revascularisation, and stroke in patients with ischaemia and non-obstructive coronary artery disease. Methods: A total of 610 patients were included and followed up over a median of 8.0 years (199 individual MACE in 174 patients). Results: 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 mmHg/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 mmHg/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.
KW - Clinical research
KW - Other technique
KW - Risk stratification
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U2 - 10.4244/EIJ-D-20-00853
DO - 10.4244/EIJ-D-20-00853
M3 - Article
C2 - 33342762
AN - SCOPUS:85117434438
SN - 1774-024X
VL - 17
SP - 569
EP - 575
JO - EuroIntervention
JF - EuroIntervention
IS - 7
ER -