Myocardial blood flow in patients after percutaneous coronary interventions before coronary artery bypass grafting compared to patients without endovascular interventions

Background. Prior endovascular interventions can trigger the development of microvascular dysfunction in patients with coronary artery disease (CAD), which can negatively impact the function of coronary artery bypass grafts after surgery. Dynamic myocardial single-photon emission computed tomography (SPECT) is a promising method for the noninvasive diagnosis of these disorders.

Aim: To evaluate myocardial blood flow using SPECT in patients with multivessel coronary artery disease and prior percutaneous coronary interventions (PCI) before coronary artery bypass grafting (CABG).

Material and Methods. A single-center prospective study was conducted, including 118 patients with CAD referred for CABG. Patients were divided into two groups: the main group (n = 60) – patients with a history of prior PCI (PCI group); the control group (n = 58) – patients without previous endovascular interventions (No PCI group). All patients underwent dynamic myocardial SPECT with a pharmacological load 2 days before surgery to assess absolute parameters of myocardial blood flow (MBF) and coronary flow reserve (CFR).

Results. Global myocardial blood flow at rest did not differ between the groups. However, under stress load conditions, global MBF and CFR were significantly lower in the PCI group compared to the No PCI group: 0.79 [0.38; 1.2] ml/min/g versus 1.01 [0.55; 1.6] ml/min/g (p = 0.001) and 1.4 [0.89; 1.8] versus 1.73 [1.35; 2.4] (p = 0.003), respectively. Selective analysis revealed a significant decrease in CFR in the anterior descending artery (1.39 [0.81; 1.57] vs. 1.75 [1.38; 1.88], p = 0.001) and circumflex artery (1.29 [0.69; 1.47] vs. 1.71 [1.1; 1.91], p = 0.013) in the PCI group.

Conclusion. Patients with previous PCI demonstrated a decrease in both MBF and CFR, indicating the development of coronary microvascular dysfunction, which is most pronounced in the left coronary artery territory. These abnormalities may impact the longterm outcomes of coronary artery bypass grafting.

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