Physiologic assessment of moderate coronary lesions: a step towards complete revascularization in coronary artery bypass grafting.

Autor:	Moscona JC; Tulane Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA, USA., Stencel JD; Department of Internal Medicine, Tulane University School of Medicine, New Orleans, LA, USA., Milligan G; Department of Internal Medicine, Tulane University School of Medicine, New Orleans, LA, USA., Salmon C; Department of Internal Medicine, Tulane University School of Medicine, New Orleans, LA, USA., Maini R; Tulane Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA, USA., Katigbak P; Tulane Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA, USA., Saleh Q; Tulane Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA, USA., Nelson R; Department of Internal Medicine, Tulane University School of Medicine, New Orleans, LA, USA., Srivastav S; Department of Global Biostatistics and Data Science, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA., Mogabgab O; Tulane Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA, USA., Samson R; Tulane Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA, USA., Le Jemtel T; Tulane Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA, USA.
Jazyk:	angličtina
Zdroj:	Annals of translational medicine [Ann Transl Med] 2018 Aug; Vol. 6 (15), pp. 300.
DOI:	10.21037/atm.2018.06.31
Abstrakt:	Background: An accurate diagnostic assessment of coronary artery disease is crucial for patients undergoing coronary artery bypass grafting (CABG). Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) to guide complete revascularization have not been adequately studied in patients prior to CABG. We compared an anatomic to a physiologic assessment of moderate coronary lesions (40-70% stenosis) in patients referred for CABG. Methods: We retrospectively reviewed 109 medical records of patients who underwent CABG at Tulane Medical Center from 2014 to 2016. Patients were divided into an FFR/iFR-guided and an angiography-guided group. Clinical characteristics, procedural outcomes, and clinical outcomes for the two groups were compared over an 18-month follow-up period. Results: There were significantly higher rates of three-vessel anastomoses (85.7% vs. 74.7%, P<0.05) and venous grafting (85.7% vs. 76.8%, P<0.05) in the FFR/iFR group. The FFR/iFR group had a lower rate of grafts placed to the left anterior descending artery (LAD) distribution than the angiography group (7.1% vs. 29.5%, P<0.05). The FFR/iFR group had a higher rate of grafts placed to the left circumflex (LCx) artery distribution than the angiography group (28.6% vs. 9.5%, P<0.05). We observed a trend toward reduction in major adverse cardiac events (MACEs) (7.1% vs. 11.6%, P=0.369) and angina (0.0% vs. 6.3%, P=0.429) in the FFR/iFR group compared to the angiography group over 18 months. Conclusions: Physiologic assessment of coronary lesions can effectively guide complete revascularization in patients undergoing CABG. Moreover, FFR/iFR-guided CABG was associated with significantly higher rates of three-vessel anastomoses, venous grafting, and graft distribution to the circumflex system. Competing Interests: Conflicts of Interest: Dr. O Mogabgab reports consultant fees from Philips Corporation. The other authors have no conflicts of interest to declare.
Databáze:	MEDLINE
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