The immediate and long-term effect of optimal balloon angioplasty on the absolute coronary blood flow velocity reserve; A subanalysis of the DEBATE study

Piek, J. J.; Boersma, E.; Voskuil, M.; D. M. rio, C.; Schroeder, E.; Vrints, C.; Probst, P.; D. B. uyne, B.; Hanet, C.; Fleck, E.; Haude, M.; Verna, E.; Voudris, V.; Geschwind, H.; Emanuelsson, H.; Muhlberger, V.; Peels, H. O.; Serruys, P. W.

Background There are limited data regarding the immediate and long-term effect of balloon angioplasty on the coronary flow reserve evaluated in a multicentre setting. Methods and Results A total of 86 patients with one-vessel disease and normal left ventricular function were analysed before and after optimal balloon angioplasty (diameter stenosis < 35%) and at 6-month follow-up. Coronary flow reserve was assessed with a Doppler guide wire. A low coronary flow reserve (ltoreq 2.5) after PTCA, due to an increased baseline blood flow velocity, was encountered in 42 of the 86 patients (49%). Recurrence of angina and target lesion revascularization were more frequent in these patients than in patients with a coronary flow reserve > 2.5 (46% vs 23% and 36% vs 16%, respectively; P < 0.05) due to a trend towards restenosis (29% vs 16%; P = 0.15) or a low coronary flow reserve at follow-up due to persistent elevated baseline blood flow velocity. Patients without restenosis showed a decrease or increase of coronary flow reserve during follow-up, determined by alterations of hyperaemic blood flow velocity. Conclusions Patients with an impaired coronary flow reserve directly after optimal balloon angioplasty showed a higher target lesion revascularization rate compared to patients with a coronary flow reserve > 2.5. This patient group consists of patients prone to develop restenosis, while other patients are characterized by a persistently low coronary flow reserve, probably secondary to disturbed autoregulation and/or diffuse mild coronary atherosclerosis. Coronary flow reserve alterations in patients without restenosis were related to changes in hyperaemic blood flow velocity, suggesting that this phenomenon relates to epicardial remodelling.