Department of Medicine, Division of Cardiology, Weatherhead P.E.T. Center, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030, USA.
Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA.
Eur Heart J. 2024 Jan 14;45(3):181-194. doi: 10.1093/eurheartj/ehad579.
Coronary flow capacity (CFC) is associated with an observed 10-year survival probability for individual patients before and after actual revascularization for comparison to virtual hypothetical ideal complete revascularization.
Stress myocardial perfusion (mL/min/g) and coronary flow reserve (CFR) per pixel were quantified in 6979 coronary artery disease (CAD) subjects using Rb-82 positron emission tomography (PET) for CFC maps of artery-specific size-severity abnormalities expressed as percent left ventricle with prospective follow-up to define survival probability per-decade as fraction of 1.0.
Severely reduced CFC in 6979 subjects predicted low survival probability that improved by 42% after revascularization compared with no revascularization for comparable severity (P = .0015). For 283 pre-and-post-procedure PET pairs, severely reduced regional CFC-associated survival probability improved heterogeneously after revascularization (P < .001), more so after bypass surgery than percutaneous coronary interventions (P < .001) but normalized in only 5.7%; non-severe baseline CFC or survival probability did not improve compared with severe CFC (P = .00001). Observed CFC-associated survival probability after actual revascularization was lower than virtual ideal hypothetical complete post-revascularization survival probability due to residual CAD or failed revascularization (P < .001) unrelated to gender or microvascular dysfunction. Severely reduced CFC in 2552 post-revascularization subjects associated with low survival probability also improved after repeat revascularization compared with no repeat procedures (P = .025).
Severely reduced CFC and associated observed survival probability improved after first and repeat revascularization compared with no revascularization for comparable CFC severity. Non-severe CFC showed no benefit. Discordance between observed actual and virtual hypothetical post-revascularization survival probability revealed residual CAD or failed revascularization.
冠状动脉血流储备（CFR）与个体患者在实际血运重建前后的 10 年生存概率相关，可用于比较实际血运重建与虚拟理想完全血运重建的差异。
采用放射性核素标记的铷-82（Rb-82）正电子发射断层扫描（PET）技术，对 6979 例冠心病（CAD）患者进行心肌灌注（mL/min/g）和每像素冠状动脉血流储备（CFR）的定量检测，以评估动脉特异性病变程度和范围与左心室百分比之间的关系。通过前瞻性随访定义每 10 年的生存概率，以 1.0 的分数表示。
6979 例患者中严重降低的 CFR 预测生存概率较低，与无血运重建相比，血运重建后（P =.0015）严重程度相似的患者的生存概率提高了 42%。对于 283 例血运重建前后的 PET 配对，严重降低的区域性 CFR 相关生存概率在血运重建后呈异质性改善（P <.001），旁路手术后改善程度大于经皮冠状动脉介入治疗（P <.001），但仅 5.7%患者恢复正常；基线非严重程度的 CFR 或生存概率与严重程度的 CFR 相比没有改善（P =.00001）。由于残余 CAD 或血运重建失败，实际血运重建后观察到的 CFR 相关生存概率低于虚拟理想完全血运重建后的生存概率（P <.001），与性别或微血管功能障碍无关。2552 例血运重建后严重降低的 CFR 与低生存概率相关，与无重复手术相比，再次血运重建后也有所改善（P =.025）。
与无血运重建相比，首次和再次血运重建后严重降低的 CFR 及其相关的观察生存概率均得到改善，而非严重程度的 CFR 则没有获益。观察到的实际与虚拟理想完全血运重建后生存概率之间的差异表明存在残余 CAD 或血运重建失败。
