Impact of final coronary flow velocity reserve on late outcome following stent implantation

Aims To assess whether coronary flow velocity reserve following stent implantation is predictive of the subsequent need of target lesion revascularization. Methods and Results The outcome was examined of 417 patients enrolled in a multicentre prospective randomized study (DESTINI), who received a successful single vessel stent implantation in native coronary arteries and in whom coronary flow velocity reserve was measured. Logistic regression analysis and the receiver operator characteristic curve were used. When compared with 358 patients not requiring target lesion revascularization, 59 patients (14%) who underwent target lesion revascularization had a lower final coronary flow velocity reserve (2.33 ± 0.87 vs 2.48 ± 0.80, P=0.20) and smaller final minimal lumen diameter (2.62 ± 0.66 mm vs 2.73 ± 0.60, P=0.19); however, those differences were not statistically significant. Patients with a coronary flow velocity reserve of <2.0 (n=109, 26%) exhibited a significantly higher target lesion revascularization rate than patients with a coronary flow velocity reserve of >2.0 (22% vs 11%, P=0.010). This difference remained significant (odds ratio=2.01, 95% CI=1.11 to 3.66) after adjustment for other variables that were also correlated with the incidence of target lesion revascularization. Conclusion The presence of a final coronary flow velocity reserve of <2.0 is an independent predictor of the need for target lesion revascularization after stent implantation in native coronary artery lesions.