Page 105 - Coronary hemodynamics in acute myocardial infarction - Matthijs Bax

Coronary autoregulation and fatal events in stable CAD
In addition, target vessel APV under baseline conditions and baseline microvascular resistance were also significantly different between the normal and abnormal reference vessel CFVR groups, whereas hyperemic APV and microvascular resistance in the target vessel did not differ significantly (Table 1).
Reference Vessel CFVR and Long-term Fatal Events
Median follow-up amounted to 11.6 years (Q1–Q3: 10.1–13.2 years). Twelve- year Kaplan–Meier estimates of cumulative all-cause mortality amounted to 16.7% in patients with a normal reference vessel CFVR and to 39.6% in patients with an abnormal reference vessel CFVR (P<0.001; Figure A), whereas 12-year Kaplan–Meier estimates of cumulative cardiac mortality amounted to 7.7% in patients with a normal reference vessel CFVR and to 31.6% in patients with an abnormal reference vessel CFVR (P<0.001; Figure B).
Of all clinical and procedural characteristics (Table 1), reference vessel CFVR
≤2.7, age >65 years, impaired left ventricular function (left ventricular ejection 6 fraction <50%), the presence of left ventricular hypertrophy, and history of angiotensin-converting enzyme inhibitor use were found to be associated
with long-term all-cause mortality in this study population (P<0.1). After multivariable adjustment, reference vessel CFVR ≤2.7 was associated with a
2.24-fold increase in mortality hazard at long-term follow-up (hazard ratio, 2.24;
95% confidence interval, 1.13–4.44; P=0.020). Furthermore, after multivariable adjustment, reference vessel CFVR was associated with a 3.32-fold increase
in cardiac mortality hazard at long-term follow-up (hazard ratio, 3.32; 95% confidence interval, 1.27–8.67; P=0.014). Additional adjustment for index
procedure treatment strategy did not alter these findings (hazard ratio for all-
cause mortality, 2.23; 95% confidence interval, 1.13–4.42; P=0.021 and hazard
ratio for cardiac mortality, 3.34; 95% confidence interval, 1.28–8.73; P=0.014).
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