Abstract

Aim To investigate the relationship between stent length and changes in microvascular resistance during PCI in stable coronary artery disease (CAD). Methods and Results We measured fractional flow reserve (FFR), index of microcirculatory resistance (IMR), and coronary flow reserve (CFR) before and after stenting in 42 consecutive subjects with stable coronary artery undergoing PCI with stent in the LAD. Patients that had very long stent length (38–78 mm) had lower FFR before stenting than patients that had long (23–37 mm) and moderate (12–22 mm) stent length (0.59 (±0.16), 0.70 (±0.12), and 0.75 (±0.07); p=0.002). FFR improved after stenting and more so in subjects with very long stent length compared to long and moderate stent length (0.27 (s.d ± 16), 0.15 (s.d ± 0.12), and 0.12 (s.d ± 0.07); p for interaction = 0.013). Corrected IMR (IMRcorr) increased after stenting in subjects who had very long stent length, whereas IMRcorr was lower after stenting in subjects who had long or moderate stent length (4.6 (s.d. ± 10.7), −1.4 (s.d. ± 9,9), and −4.2 (s.d. ± 7.8); p for interaction = 0.009). Conclusions Changes in IMR during PCI in the LAD in stable CAD seem to be related to total length of stents implanted, possibly influencing post-PCI FFR. Larger studies are needed to confirm the relationship.

Highlights

  • Fractional ow reserve (FFR) is a validated and reproducible measure of the functional severity of a coronary artery lesion [1, 2]

  • Changes in Index of microcirculatory resistance (IMR) during PCI in the LAD in stable coronary artery disease (CAD) seem to be related to total length of stents implanted, possibly in uencing post-PCI Fractional flow reserve (FFR)

  • We report pre- to post-PCI changes in FFR, coronary flow reserve (CFR), and IMR in relation to total stent length and other variables in subjects treated with PCI in the LAD who had flow indices measured both before and after PCI (n 42)

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Summary

Introduction

Fractional ow reserve (FFR) is a validated and reproducible measure of the functional severity of a coronary artery lesion [1, 2]. Higher post-PCI FFR is associated with better outcome [5, 6]. Increased coronary microvascular resistance is associated with higher post-PCI FFR [7], and coronary microvascular dysfunction (CMVD) is associated with long-term recurrence of restenosis [8]. Index of microcirculatory resistance (IMR) is a validated measurement of coronary microvascular resistance [9], and high IMR (>25 units) can be considered to be a proxy for CMVD [10]. IMR is measured simultaneously with FFR [11]; the physiological signi cance of epicardial lesions and the coronary microcirculatory function can be concurrently assessed

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