Intervenciones coronarias percutáneas guiadas con medición de flujo de reserva coronario

the treatment of coronary stenosis causing myocardial ischemia improves functional capacity and prognosis. treatment of non-ischemia inducing coronary stenosis may lead to complications with no benefit to the patient measurement of coronary flow reserve (cfr) may be used to assess the significance of coronary artery stenosis. aim: to compare major adverse cardiovascular events (mace) in patients with significant stenosis (cfr < 0.75), with those in which one or more stenosis was not significant (cfr > 0.75) and thus were not subjected to ptca in the corresponding artery. methods: 74 patients were included from august 2006 to july 2010. cfr was measured in lesions exhibiting 6070% stenosis, using adenosine. a value <0.75 was considered significant and led to ptca. patients were followed for death, myocardial infarction, revascularization and/or angina. results: 35 patients (47%) constituted the >0.75 cfr group. after evaluation of cfr the number of significant coronary stenosis decreased from 51.4% to 25.7%. they received a mean of 0.7 stents per patient. on the other hand, in the group with cfr <0.75 (39 patients) the mean number of stents was 1.5. patients were followed for a mean of 21.5 months. 28 mace events were observed in 19 patients (25.6%). no deaths were observed. multivariable analysis revealed no significant difference between groups regarding myocardial infarction or angina. the need for myocardial revascularization was greater in the cfr <0.75 group compared to the cfr >0.75 group (12.8% vs 2.9%, respectively, p=0.047). conclusion: the exclusion of myocardial ischemia as inferred by a cfr >0.75 allowed a significantly lower number of ptcas without increase in mace at a medium term follow up. a greater number of revascularization procedures was required in patients with cfr <0.75, which is expected from the greater number of lesions subjected to ptca.