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Coronary flow capacity and survival prediction after revascularization: physiological basis and clinical implications. | LitMetric

AI Article Synopsis

  • Coronary flow capacity (CFC) is linked to patient survival over ten years, with improvements noted after revascularization procedures compared to if no revascularization occurred.
  • A study on 6,979 coronary artery disease patients used PET imaging to assess CFC and determine survival probabilities, revealing that significantly low CFC correlates to a lower survival rate.
  • Results showed that while revascularization improved survival odds, particularly with bypass surgery, the outcomes were still below those of an idealized scenario and non-severe CFC did not demonstrate any benefit.

Article 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.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10787661PMC
http://dx.doi.org/10.1093/eurheartj/ehad579DOI Listing

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