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

K Lance Gould; Nils P Johnson; Amanda E Roby; Linh Bui; Danai Kitkungvan; Monica B Patel; Tung Nguyen; Richard Kirkeeide; Mary Haynie; Salman A Arain; Konstantinos Charitakis; Abhijeet Dhoble; Richard Smalling; Angelo Nascimbene; Marwan Jumean; Sachin Kumar; Biswajit Kar; Stefano Sdringola; Anthony Estrera; Igor Gregoric; Dejian Lai; Ruosha Li; David McPherson; Jagat Narula

doi:10.1093/eurheartj/ehad579

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

Eur Heart J. 2024 Jan 14;45(3):181-194. doi: 10.1093/eurheartj/ehad579.

Authors

K Lance Gould^{1

2}, Nils P Johnson^{1

2}, Amanda E Roby^{1

2}, Linh Bui^{1

2}, Danai Kitkungvan^{1

2}, Monica B Patel^{1

2}, Tung Nguyen^{1

2}, Richard Kirkeeide^{1

2}, Mary Haynie^{1

2}, Salman A Arain², Konstantinos Charitakis², Abhijeet Dhoble², Richard Smalling², Angelo Nascimbene³, Marwan Jumean³, Sachin Kumar³, Biswajit Kar³, Stefano Sdringola², Anthony Estrera⁴, Igor Gregoric³, Dejian Lai⁵, Ruosha Li⁵, David McPherson², Jagat Narula^{1

2}

Affiliations

¹ Department of Medicine, Division of Cardiology, Weatherhead P.E.T. Center, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030, USA.
² Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA.
³ Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, TX, USA.
⁴ Department of Cardiothoracic Vascular Surgery, McGovern Medical School, University of Texas Health Science Center, Memorial Hermann Hospital, Houston, TX, USA.
⁵ Department of Biostatistics and Data Science, University of Texas School of Public Health-Houston, Houston, TX, USA.

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.

Keywords: Coronary artery disease; Coronary bypass surgery; Coronary flow reserve; Myocardial ischaemia; Myocardial perfusion; PET imaging.

MeSH terms

Coronary Angiography / methods
Coronary Artery Disease*
Humans
Positron-Emission Tomography / methods
Prospective Studies
Rubidium Radioisotopes

Substances

Rubidium-82
Rubidium Radioisotopes

Abstract

MeSH terms

Substances

Grants and funding