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(Circulation. 1997;96:3369-3377.)
© 1997 American Heart Association, Inc.
Articles |
Prognostic Value of Intracoronary Flow Velocity and Diameter Stenosis in Assessing the Short- and Long-term Outcomes of Coronary Balloon Angioplasty
The DEBATE Study (Doppler Endpoints Balloon Angioplasty Trial Europe)
Correspondence to P.W. Serruys, Department of Coronary Diagnostics and Interventions, Thoraxcenter, PO Box 1738, 3000 Dr Rotterdam, Netherlands.
Background The aim of this prospective, multicenter study was the identification of Doppler flow velocity measurements predictive of clinical outcome of patients undergoing single-vessel balloon angioplasty with no previous Q-wave myocardial infarction.
Methods and Results In 297 patients, a Doppler
guidewire was used to measure basal and maximal hyperemic flow
velocities proximal and distal to the stenosis before and after
angioplasty. In 225 patients with an angiographically successful
percutaneous transluminal coronary angioplasty
(PTCA), postprocedural distal coronary flow reserve (CFR) and
percent diameter stenosis (DS%) were correlated with symptoms
and/or ischemia at 1 and 6 months, with the need for target
lesion revascularization, and with angiographic
restenosis (defined as DS 
50% at follow-up). Logistic
regression and receiver operator characteristic curve analyses
were applied to determine the prognostic cutoff value of CFR and DS
separately and in combination. Optimal cutoff criteria for predictors
of these clinical events were DS, 35%; CFR, 2.5. A distal CFR after
angioplasty >2.5 with a residual DS 
35% identified lesions with a
low incidence of recurrence of symptoms at 1 month (10% versus
19%, P=.149) and at 6 months (23% versus 47%,
P=.005), a low need for reintervention (16% versus 34%,
P=.024), and a low restenosis rate (16% versus
41%, P=.002) compared with patients who did not meet these
criteria.
Conclusions Measurements of distal CFR after PTCA, in combination with DS%, have a predictive value, albeit modest for the short- and long-term outcomes after PTCA, and thus may be used to identify patients who will or will not benefit from additional therapy such as stent implantation.
Key Words: stenosis • balloon • prognosis • angioplasty
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