Imperial College London
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DrJamesHoward

Faculty of Medicine, National Heart & Lung Institute

Clinical Senior Lecturer in Cardiology (Cardiac MR and AI)
 
 
 
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james.howard1 Website CV

 
 
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Location

 

Block B Hammersmith HospitalHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@article{Kelshiker:2022:eurheartj/ehab775,
author = {Kelshiker, M and Seligman, H and Howard, JAMES and Rahman, H and Foley, M and Nowbar, A and Rajkumar, C and Shun-Shin, M and Ahmad, Y and Sen, S and Al-Lamee, R and Cole, G and Hoole, S and Morris, P and Rigo, F and Mayet, J and Francis, D and Petraco, R},
doi = {eurheartj/ehab775},
journal = {European Heart Journal},
pages = {1582--1593},
title = {Coronary flow reserve and cardiovascular outcomes: a systematic review and meta-analysis},
url = {http://dx.doi.org/10.1093/eurheartj/ehab775},
volume = {43},
year = {2022}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Aims: This meta-analysis aims to quantify the association of reduced coronary flow with all3 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 1st January 2000 and1st 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 using a random-effects model. 79 studies, including 59,740 subjects were included. Abnormal coronary flow reserve (CFR) was associated with a higher incidence of all-cause mortality (HR 3.78, 95% 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). Conclusions: 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
AU  - Kelshiker,M
AU  - Seligman,H
AU  - Howard,JAMES
AU  - Rahman,H
AU  - Foley,M
AU  - Nowbar,A
AU  - Rajkumar,C
AU  - Shun-Shin,M
AU  - Ahmad,Y
AU  - Sen,S
AU  - Al-Lamee,R
AU  - Cole,G
AU  - Hoole,S
AU  - Morris,P
AU  - Rigo,F
AU  - Mayet,J
AU  - Francis,D
AU  - Petraco,R
DO  - eurheartj/ehab775
EP  - 1593
PY  - 2022///
SN  - 0195-668X
SP  - 1582
TI  - Coronary flow reserve and cardiovascular outcomes: a systematic review and meta-analysis
T2  - European Heart Journal
UR  - http://dx.doi.org/10.1093/eurheartj/ehab775
UR  - http://hdl.handle.net/10044/1/92537
VL  - 43
ER  -
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