Angiography-Based Blood Flow Quantification After Revascularization in Acute Coronary Syndromes.

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.