The immediate and long-term effect of optimal balloon angioplasty on the absolute coronary blood flow velocity reserve - A subanalysis of the DEBATE study

Background There are limited data regarding the immediate and long-term eff ect of balloon angioplasty on the coronary flow reserve evaluated in a mult icentre setting. Methods and Results A total of 86 patients with one-vessel disease and norm al left ventricular function were analysed before and after optimal balloon angioplasty (diameter stenosis <35%) and at 6-month follow-up. Coronary fl ow reserve was assessed with a Doppler guide wire. A low coronary flow rese rve (<less than or equal to>2.5) after PTCA, due to an increased baseline b lood flow velocity, was encountered in 42 of the 86 patients (49%). Recurre nce of angina and target lesion revascularization were more frequent in the se patients than in patients with a coronary flow reserve >2.5 (46% vs 23% and 36% vs 16%, respectively; P<0.05) due to a trend towards restenosis (29 % vs 16%; P=0.15) or a low coronary flow reserve at follow-up due to persis tent elevated baseline blood flow velocity. Patients without restenosis sho wed a decrease or increase of coronary flow reserve during follow-up, deter mined by alterations of hyperaemic blood flow velocity. Conclusions Patients with an impaired coronary flow reserve directly after optimal balloon angioplasty showed a higher target lesion revascularization rate compared to patients with a coronary flow reserve >2.5. This patient group consists of patients prone to develop restenosis, while other patient s are characterized by a persistently low coronary flow reserve, probably s econdary to disturbed autoregulation and/or diffuse mild coronary atheroscl erosis. Coronary flow reserve alterations in patients without restenosis we re related to changes in hyperaemic blood flow velocity, suggesting that th is phenomenon relates to epicardial remodelling.