PROGNOSTIC VALUE OF INTRACORONARY FLOW VELOCITY AND DIAMETER STENOSISIN ASSESSING THE SHORT-TERM AND LONG-TERM OUTCOMES OF CORONARY BALLOON ANGIOPLASTY - THE DEBATE STUDY (DOPPLER END-POINTS BALLOON ANGIOPLASTY TRIAL EUROPE)

Background The aim of this prospective, multicenter study was the iden tification of Doppler flow velocity measurements predictive of clinica l outcome of patients undergoing single-vessel balloon angioplasty wit h no previous Q-wave myocardial infarction. Methods and Results In 297 patients, a Doppler guidewire was used to measure basal and maximal h yperemic flow velocities proximal and distal to the stenosis before an d after angioplasty. In 225 patients with an angiographically successf ul percutaneous transluminal coronary angioplasty (PTCA), post-procedu ral distal coronary flow reserve (CFR) and percent diameter stenosis ( DS%) were correlated with symptoms and/or ischemia at 1 and 6 months, with the need for target lesion revascularization, and with angiograph ic restenosis (defined as DS greater than or equal to 50% at follow-up ). Logistic regression and receiver operator characteristic curve anal yses were applied to determine the prognostic cutoff value of CFR and DS separately and in combination. Optimal cutoff criteria for predicto rs of these clinical events were DS, 35%; CFR, 2.5. A distal CFR after angioplasty >2.5 with a residual DS less than or equal to 35% identif ied lesions with a low incidence of recurrence of symptoms at 1 month (10% versus 19%, P=.149) and at 6 months (23% versus 47%, P=.005), a l ow need for reintervention (16% versus 34%, P=.024), and a low resteno sis rate (16% versus 41%, P=.002) compared with patients who did nor m eet these criteria. Conclusions Measurements of distal CFR after PTCA, in combination with DS%, have a predictive value, albeit modest for t he short-and long-term outcomes after PTCA, and thus may be used to id entify patients who will or will not benefit from additional therapy s uch as stent implantation.