Prognostic value of global coronary flow reserve improvement after percutaneous coronary intervention in patients with chronic coronary syndrome

Abstract

Abstract Background Impaired global coronary flow reserve (g-CFR) evaluated by phase-contrast cine cardiovascular magnetic resonance (PC-CMR) has been reported to be associated with worse outcomes in patients with cardiovascular disease. Purpose This study aimed to evaluate the prognostic value of g-CFR improvement evaluated by PC-CMR in patients with chronic coronary syndrome (CCS). Methods A total of 320 patients with CCS who underwent pre- and post-PCI PC-CMR measurements and stress perfusion CMR were followed-up to determine the predictors of major adverse cardiovascular events (MACE). The association between CMR variables including changes in G-CFR after PCI and MACE (cardiac death, nonfatal myocardial infarction, hospitalization for heart failure, or ischemic stroke) was investigated. Results G-CFR improvement was observed in 162 (50.6%) and MACE occurred in 26 (8.1%) during follow-up (2.5 year, 1.3-4.0). G-CFR improvement was significantly associated with lower pre-PCI G-CFR (p<0.001). Patients with MACE showed lower pre-PCI G-CFR, a high prevalence of post-PCI positive stress perfusion, non-G-CFR improvement. In Kaplan-Meier analysis, patients without G-CFR improvement were significantly associated with poor prognosis (log-rank χ2=5.8, P=0.018). After adjusting the presence of post-PCI positive stress perfusion, non-G-CFR improvement was an independent predictor of MACE (P=0.007). Conclusion In addition to the association between lower pre-PCI G-CFR and worse prognosis, G-CFR improvement after PCI may provide a novel insight into the prognosis after PCI in patients with CCS.Kaplan-Meier analysis