High disturbed flow in stent-implanted region predicts target lesion revascularization after everolimus-eluting stent implantation in hemodialysis

Background: High disturbed coronary blood flow was reported to increase the risk of adverse events. The purpose of this study was to assess predictive values of coronary flow velocity (CFV) and an index of disturbed flow for target lesion revascularization (TLR) after everolimus-eluting stent (EES) implantation in hemodialysis (HD) patients. Methods and results: The study group consisted of 81HD patients with 100 coronary lesions (age 69.9±9.1 years, mean ± SD, 59 male) who underwent successful percutaneous coronary intervention (PCI) with EES implantation. The TIMI frame count method and quantitative digital angiographic analysis were performed based on the post-PCI angiogram. CFV (vessel length/TIMI frame count/15) and an index of disturbed flow (Reynolds number: velocity/diameter/density/viscosity) were measured both throughout the target vessel and in the stent-implanted region. Target lesion revascularization (TLR) occurred in 12 lesions (12.0%) at the follow-up period of 20.9±10.4 months. There were no significant differences between TLR group (12 lesions) and Non-TLR group (88 lesions) in terms of CFV and Reynolds number throughout the target vessel (195.4±66.8mm/sec vs. 159.8±56.6, p=0.17, 153.4±75.4 vs. 119.7±59.4, p=0.08, respectively). However, in the stent-implanted region, CFV and Reynolds number of the TLR group were significantly higher than the Non-TLR group (222.8±70.7mm/sec vs. 160.5±77.2, p=0.006, 186.1±65.7 vs. 132.4±71.2, p=0.01, respectively). Multivariate analysis showed that Reynolds number in the stent-implanted region after EES was an independent predictor of TLR in the HD patients (OR: 1.01, 95% CI: 1.00-1.023, p=0.02). Conclusion: In the stent-implanted region, CFV and Reynolds number were significantly higher in the TLR group than the Non-TLR group. High disturbed flow in stent-implanted region after EES may predict the risk of TLR in HD patients.