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Multicenter Study
. 2025 Jul;14(13):e038770.
doi: 10.1161/JAHA.124.038770. Epub 2025 Jun 27.

Angiography-Based Blood Flow Quantification After Revascularization in Acute Coronary Syndromes

Koshiro Sakai  1   2 , Takuya Mizukami  1   3   4 , Hirofumi Ohashi  5 , Frederic Bouisset  1   6 , Giulia Botti  1   7 , Nobuaki Kobayashi  8 , Masamichi Takano  8 , Seita Kondo  2 , Tomoyo Sugiyama  9 , Tsunekazu Kakuta  9 , Kohei Wakabayashi  10 , Satoru Suwa  11 , Tomotaka Dohi  12 , Hiroyoshi Mori  13 , Shigeki Kimura  14 , Satoru Mitomo  15 , Sunao Nakamura  15 , Takumi Higuma  16 , Junichi Yamaguchi  17 , Taishi Yonetsu  18 , Makoto Natsumeda  19 , Yuji Ikari  19 , Jun Yamashita  20 , Myong H Yamamoto  3 , Adriaan Wilgenhof  1   21 , Jeroen Sonck  1 , Toshiro Shinke  2 , Chris Bouwman  22 , Jean-Paul Aben  22 , Carlos Collet  1
Affiliations
Multicenter Study

Angiography-Based Blood Flow Quantification After Revascularization in Acute Coronary Syndromes

Koshiro Sakai et al. J Am Heart Assoc. 2025 Jul.

Abstract

Background: In patients presenting with acute coronary syndromes (ACS), impaired coronary blood flow (CBF) after percutaneous coronary interventions (PCI) is linked to mortality. We developed a novel angiography-based approach for blood flow quantification using automatic contrast bolus tracking. Therefore, this study aimed to investigate the clinical impact of angiography-based blood flow quantification on major adverse cardiovascular events (MACE) after PCI in patients with ACS.

Methods: Prospective, multicenter, nested case-control study of patients presenting ACS. A propensity score was used to match patients with and without MACE at 1 year of follow-up. MACE was defined as cardiovascular death, myocardial infarction, hospitalization for heart failure, or ischemia-driven revascularization. CBF was measured automatically from angiograms after PCI.

Results: One hundred sixty-two patients were included. The mean age was 68.3±13.0 years, 83% were male, and 33% had diabetes. Overall, 66% of patients presented with ST-segment-elevation myocardial infarction. CBF after PCI was lower after ST-segment-elevation myocardial infarction compared with other clinical presentations (74.1±47.0 mL/min ST-segment-elevation myocardial infarction, 89.1±45.8 mL/min, non-ST-segment-elevation myocardial infarction, 95.7±48.8 mL/min, unstable angina, P=0.046). Patients with low post-PCI CBF (<54.3 mL/min) had an increased risk of MACE (hazard ratio, 2.11 [95% CI, 1.35-3.28], P=0.001).

Conclusions: After PCI, automatic quantification of CBF using angiography was associated with MACE in patients with ACS. Risk stratification using post-PCI CBF-derived angiography may enable tailored management strategies for individuals with ACS.

Keywords: acute coronary syndrome; angiography; coronary blood flow; coronary flow velocity; heart failure.

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Conflict of interest statement

Takuya Mizukami received consultancy fees from Zeon Medical Inc., research grants from Boston Scientific, and speaker fees from Abbott Vascular, Cathworks, and Boston Scientific. Junichi Yamaguchi was endowed by Abbott Medical Japan LLC, Boston Scientific, Medtronic, and Terumo. Toshiro Shinke received personal fees and research grants from Abbott Medical Japan LLC. Adriaan Wilgenhof has been supported by a research grant provided by the DigiCardiopaTh PhD program. Chris Bouwman and Jean‐Paul Aben are employees of Pie Medical Imaging. Carlos Collet reports receiving research grants from Biosensor, Coroventis Research, Medis Medical Imaging, Pie Medical Imaging, CathWorks, Boston Scientific, Siemens, HeartFlow Inc, Abbott Vascular, and consultancy fees from HeartFlow Inc, OpSens, Abbott Vascular, and Philips Volcano. The remaining authors have no disclosures to report.

Figures

Figure 1
Figure 1. Distribution of angiography‐based flow velocity and coronary blood flow.
Left, the distribution of angiography‐based flow velocity. Right, the distribution of CBF. Patients with MACE are shown in orange, and controls are shown in gray. CBF indicates coronary blood flow; and MACE, major adverse cardiovascular events.
Figure 2
Figure 2. Comparison of CBF between clinical presentations of ACS.
The plot shows the comparison of angiography‐based CBF between the clinical presentation of ACS (STEMI in red, NSTEMI in yellow, and UAP in green). ACS indicates acute coronary syndrome; CBF, coronary blood flow; NSTEMI, non‐ST‐segment–elevation myocardial infarction; STEMI, ST‐segment–elevation myocardial infarction; and UAP, unstable angina.
Figure 3
Figure 3. Kaplan–Meier survival curve from primary revascularization for cardiovascular events in patients with acute coronary syndromes.
This figure illustrates the 1‐year survival rates over time for patients with low angiography‐based CBF (blue line) and normal CBF (red line). Low CBF was defined as less than the lowest tertile in this cohort (<54.3 mL/min). The left panel shows Kaplan–Meier survival curve for MACE, composed of cardiovascular death, nonfatal myocardial infarction, hospitalization of HF, or ischemia‐driven revascularization. The right panel shows Kaplan–Meier survival curve for hospitalization of HF. CBF indicates coronary blood flow; HF, heart failure; HR, hazard ratio; and MACE, major adverse cardiovascular events.
See this image and copyright information in PMC

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