(Circulation. 2000;101:962.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Prediction of Restenosis After Coronary Angioplasty by Use of a New Index
TIMI Frame Count/Minimal Luminal Diameter Ratio
Presented in part at the XIXth European Congress of Cardiology, Stockholm, August 24–28, 1997.
From the 1st Cardiology Department, Onassis Cardiac Surgery Center (A.M., V.V., G.P., G.A., D.V.C.), Athens, Greece, and the Institute of Cardiovascular Diseases, University Clinical Center (G.S., M.O.), Belgrade, Yugoslavia.
Correspondence to Dennis V. Cokkinos, MD, Professor of Cardiology, University of Athens, 1st Cardiology Department, Onassis Cardiac Surgery Center, 356 Sygrou Ave, 176 74 Athens, Greece.
Background—It has been shown recently that postangioplasty coronary flow reserve and the degree of residual stenosis have a modest predictive value for short- and long-term clinical outcomes after coronary angioplasty. Corrected TIMI frame count (CTFC) is a simple quantitative index of coronary blood flow. Its relationship with Doppler coronary flow velocity and clinical outcome after coronary angioplasty has not been fully clarified. The aim of this study was to identify clinical, angiographic, and functional predictors of clinical and angiographic restenosis after conventional coronary angioplasty.
Methods and Results—We studied 70 consecutive patients in whom intracoronary Doppler flow-velocity measurements were performed before and after angioplasty. Patients were evaluated for restenosis by clinical follow-up, exercise stress test/201Tl scintigraphy, and follow-up angiography, which was performed at 10.5±10.3 months in 63 patients. According to the results of univariate analysis, a new index, postangioplasty CTFC/minimal luminal diameter (MLD) ratio, was created. Multivariate analysis revealed that CTFC/MLD ratio was the only independent predictor of angiographic (OR 2.02; 95% CI 1.37 to 2.97; P<0.0004) and clinical (OR 1.60; 95% CI 1.15 to 2.21; P<0.005) restenosis. The receiver operating characteristic curve area of this index was 79% for angiographic and 73% for clinical restenosis. The optimal CTFC/MLD ratio cutoff values were 7.88 for angiographic and 7.94 for clinical restenosis, respectively.
Conclusions—Our data indicate that postangioplasty CTFC/MLD ratio, which incorporates both the angiographic and functional features of coronary lesions, is a reliable, objective, and inexpensive index for prediction of angiographic and clinical restenosis after conventional coronary angioplasty.
Key Words: angioplasty • blood flow • restenosis • coronary disease
This article has been cited by other articles:
 |
|
 |
|
  I. Barutcu, A. T. Sezgin, H. Gullu, M. Turkmen, and A. M. Esen Assessing Coronary Blood Flow With TIMI Frame Count Method in Isolated Myocardial Bridging Angiology, June 1, 2007; 58(3): 283 - 288. [Abstract] [PDF]
|
|
|
|
 |
|
 C. M. Gibson, A. J. Kirtane, K. Boundy, H. Ly, D. Karmpaliotis, S. A. Murphy, R. P. Giugliano, C. P. Cannon, E. M. Antman, E. Braunwald, et al. Association of a negative residual stenosis following rescue/adjunctive percutaneous coronary intervention with impaired myocardial perfusion and adverse outcomes among ST-segment elevation myocardial infarction patients J. Am. Coll. Cardiol., February 1, 2005; 45(3): 357 - 362. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y Ohara, Y Hiasa, T Takahashi, K Yamaguchi, R Ogura, T Ogata, K Yuba, K Kusunoki, S Hosokawa, K Kishi, et al. Relation between the TIMI frame count and the degree of microvascular injury after primary coronary angioplasty in patients with acute anterior myocardial infarction Heart, January 1, 2005; 91(1): 64 - 67. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Kettelkamp, J. House, M. Garg, R. S. Stuart, A. Grantham, and J. Spertus Using the Risk of Restenosis as a Guide to Triaging Patients Between Surgical and Percutaneous Coronary Revascularization Circulation, September 14, 2004; 110(11_suppl_1): II-50 - II-54. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. K. Chugh, J. Koppel, M. Scott, L. Shewchuk, D. Goodhart, R. Bonan, J.-C. Tardif, S. G. Worthley, C. DiMario, M. J. Curtis, et al. Coronary flow velocity reserve does not correlate with TIMI frame count in patients undergoing non-emergency percutaneous coronary intervention J. Am. Coll. Cardiol., August 18, 2004; 44(4): 778 - 782. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. M. Gibson and A. Schomig Coronary and Myocardial Angiography: Angiographic Assessment of Both Epicardial and Myocardial Perfusion Circulation, June 29, 2004; 109(25): 3096 - 3105. [Full Text] [PDF]
|
|
|
|
|
|
D V Cokkinos, A Manginas, and V Voudris Coronary flow: clinical considerations Heart, April 1, 2003; 89(4): 361 - 363. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Kinlay, J. Grewal, D. Manuelin, J. C. Fang, A. P. Selwyn, J. A. Bittl, and P. Ganz Coronary Flow Velocity and Disturbed Flow Predict Adverse Clinical Outcome After Coronary Angioplasty Arterioscler. Thromb. Vasc. Biol., August 1, 2002; 22(8): 1334 - 1340. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Beran, I. Lang, W. Schreiber, S. Denk, T. Stefenelli, B. Syeda, G. Maurer, D. Glogar, and P. Siostrzonek Intracoronary Thrombectomy With the X-Sizer Catheter System Improves Epicardial Flow and Accelerates ST-Segment Resolution in Patients With Acute Coronary Syndrome: A Prospective, Randomized, Controlled Study Circulation, May 21, 2002; 105(20): 2355 - 2360. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. R. Ward, P. S. Tsao, A. Agrotis, R. J. Dilley, G. L. Jennings, and A. Bobik Low Blood Flow After Angioplasty Augments Mechanisms of Restenosis : Inward Vessel Remodeling, Cell Migration, and Activity of Genes Regulating Migration Arterioscler. Thromb. Vasc. Biol., February 1, 2001; 21(2): 208 - 213. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. P. Faxon Predicting Restenosis : Bigger Is Better but Not Best Circulation, March 7, 2000; 101(9): 946 - 947. [Full Text] [PDF]
|
|