Kelshiker, M.A. orcid.org/0000-0002-8189-7571, Seligman, H. orcid.org/0000-0002-4244-860X, Howard, J.P. orcid.org/0000-0002-9989-6331 et al. (9 more authors) (2022) Coronary flow reserve and cardiovascular outcomes: a systematic review and meta-analysis. European Heart Journal, 43 (16). pp. 1582-1593.
Abstract
AIMS: This meta-analysis aims to quantify the association of reduced coronary flow with all-cause mortality and major adverse cardiovascular events (MACE) across a broad range of patient groups and pathologies. METHODS AND RESULTS: We systematically identified all studies between 1 January 2000 and 1 August 2020, where coronary flow was measured and clinical outcomes were reported. The endpoints were all-cause mortality and MACE. Estimates of effect were calculated from published hazard ratios (HRs) using a random-effects model. Seventy-nine studies with a total of 59 740 subjects were included. Abnormal coronary flow reserve (CFR) was associated with a higher incidence of all-cause mortality [HR: 3.78, 95% confidence interval (CI): 2.39-5.97] and a higher incidence of MACE (HR 3.42, 95% CI: 2.92-3.99). Each 0.1 unit reduction in CFR was associated with a proportional increase in mortality (per 0.1 CFR unit HR: 1.16, 95% CI: 1.04-1.29) and MACE (per 0.1 CFR unit HR: 1.08, 95% CI: 1.04-1.11). In patients with isolated coronary microvascular dysfunction, an abnormal CFR was associated with a higher incidence of mortality (HR: 5.44, 95% CI: 3.78-7.83) and MACE (HR: 3.56, 95% CI: 2.14-5.90). Abnormal CFR was also associated with a higher incidence of MACE in patients with acute coronary syndromes (HR: 3.76, 95% CI: 2.35-6.00), heart failure (HR: 6.38, 95% CI: 1.95-20.90), heart transplant (HR: 3.32, 95% CI: 2.34-4.71), and diabetes mellitus (HR: 7.47, 95% CI: 3.37-16.55). CONCLUSION: Reduced coronary flow is strongly associated with increased risk of all-cause mortality and MACE across a wide range of pathological processes. This finding supports recent recommendations that coronary flow should be measured more routinely in clinical practice, to target aggressive vascular risk modification for individuals at higher risk.
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Copyright, Publisher and Additional Information: | © The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com | ||||
Keywords: | Cardiology; Cardiovascular risk; Coronary flow reserve; Interventional; Microvascular disease; Humans; Fractional Flow Reserve, Myocardial; Myocardial Ischemia; Proportional Hazards Models; Acute Coronary Syndrome; Cardiovascular System; Coronary Artery Disease; Prognosis | ||||
Dates: |
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Institution: | The University of Sheffield | ||||
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Medicine and Population Health | ||||
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Depositing User: | Symplectic Sheffield | ||||
Date Deposited: | 14 Feb 2024 15:31 | ||||
Last Modified: | 14 Feb 2024 15:31 | ||||
Status: | Published | ||||
Publisher: | Oxford University Press | ||||
Refereed: | Yes | ||||
Identification Number: | https://doi.org/10.1093/eurheartj/ehab775 | ||||
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