Angiography‐Based Blood Flow Quantification After Revascularization in Acute Coronary Syndromes

Abstract

Background In patients presenting with acute coronary syndromes (ACS), impaired coronary blood flow (CBF) after percutaneous coronary interventions (PCI) is linked to mortality. We developed a novel angiography‐based approach for blood flow quantification using automatic contrast bolus tracking. Therefore, this study aimed to investigate the clinical impact of angiography‐based blood flow quantification on major adverse cardiovascular events (MACE) after PCI in patients with ACS. Methods Prospective, multicenter, nested case–control study of patients presenting ACS. A propensity score was used to match patients with and without MACE at 1 year of follow‐up. MACE was defined as cardiovascular death, myocardial infarction, hospitalization for heart failure, or ischemia‐driven revascularization. CBF was measured automatically from angiograms after PCI. Results One hundred sixty‐two patients were included. The mean age was 68.3±13.0 years, 83% were male, and 33% had diabetes. Overall, 66% of patients presented with ST‐segment–elevation myocardial infarction. CBF after PCI was lower after ST‐segment–elevation myocardial infarction compared with other clinical presentations (74.1±47.0 mL/min ST‐segment–elevation myocardial infarction, 89.1±45.8 mL/min, non‐ST‐segment–elevation myocardial infarction, 95.7±48.8 mL/min, unstable angina, P=0.046). Patients with low post‐PCI CBF (<54.3 mL/min) had an increased risk of MACE (hazard ratio, 2.11 [95% CI, 1.35–3.28], P=0.001). Conclusions After PCI, automatic quantification of CBF using angiography was associated with MACE in patients with ACS. Risk stratification using post‐PCI CBF‐derived angiography may enable tailored management strategies for individuals with ACS.

Keywords

• acute coronary syndrome
• angiography
• coronary blood flow
• coronary flow velocity
• heart failure