Evaluation of the long-term functional outcome assessed by myocardial perfusion scintigraphy following excimer laser angioplasty compared to balloon angioplasty in longer coronary lesions

Autor: Appelman, Yolande E.A., Piek, Jan J., Van Der Wall, Ernst E., Redekop, William K., Van Royen, Eric A., Fioretti, Paolo M., De Feyter, Pim J., Koolen, Jacques J., Strikwerda, Sipke, Serruys, Patrick W., David, George K., Tijssen, Jan G.P., Lie, Kong I.
Přispěvatelé: Cardiology, ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, VU University medical center
Jazyk: angličtina
Rok vydání: 2000
Zdroj: Appelman, Y E A, Piek, J J, Van Der Wall, E E, Redekop, W K, Van Royen, E A, Fioretti, P M, De Feyter, P J, Koolen, J J, Strikwerda, S, Serruys, P W, David, G K, Tijssen, J G P & Lie, K I 2000, ' Evaluation of the long-term functional outcome assessed by myocardial perfusion scintigraphy following excimer laser angioplasty compared to balloon angioplasty in longer coronary lesions ', International Journal of Cardiac Imaging, vol. 16, no. 4, pp. 267-277 . https://doi.org/10.1023/A:1026576223669
International Journal of Cardiac Imaging, 16(4), 267-277. Kluwer Academic Publishers
ISSN: 0167-9899
Popis: Objectives: Evaluation of the long-term functional outcome assessed by exercise myocardial perfusion imaging following excimer laser angioplasty compared to balloon angioplasty in coronary lesions > 10 mm in length. Background: Previous randomized studies evaluating the effect of coronary interventions mainly focused on the long-term clinical and angiographic outcome. The functional outcome, assessed by myocardial perfusion scintigraphy, has not been evaluated in a randomized setting. Methods: A total of 308 patients with stable angina and a longer coronary lesion “> 10 mm” were randomized to excimer laser angioplasty or balloon angioplasty. A 99mTechnetium-2-methoxy isobutyl isonitrile “MIBI” single-photon emission computed tomography “SPECT” study was performed in 139 patients before the initial angioplasty procedure and at 6 months follow-up “73 patients in the laser group versus 66 patients in the balloon group, respectively”. Exercise tolerance at follow-up was compared to baseline values by means of exercise duration and double product at peak exercise. Myocardial perfusion of the randomized vascular bed was assessed semi-quantitatively on the MIBI SPECT images. The reversible defects were graded as mild, moderate or severe. Myocardial perfusion at follow-up was expressed as a percentage reduction in incidence and grading of the reversible defects compared to baseline values. Results: Forty-four “61%” patients assigned to laser angioplasty were asymptomatic at 6 months follow-up compared to 34 “52%” patients assigned to balloon angioplasty “p = NS”. Improvement in exercise duration and double product were 0.7 ± 2.1 min and 4.3 ± 6.2 min/mmHg/1000, respectively, in the laser group, versus 0.3 ± 2.5 min and 3.1 ± 5.5 min/mmHg/1000, respectively, in the balloon group “both p = NS”. The percentage reduction of reversible defects was 23% in patients assigned to laser angioplasty vs. 29% in patients assigned to balloon angioplasty “Relative risk [RR]: 0.79, 95% confidence interval [CI]: 0.40-1.57; p = 0.50”. The mild, moderate and severe reversible defects improved in 44.4, 63.6 and 66.6%, respectively, in the laser angioplasty group vs. 66.6, 53.8 and 90%, respectively, in the balloon angioplasty group. None of the comparisons were significantly different. Conclusion: Excimer laser angioplasty compared to balloon angioplasty in coronary lesions > 10 mm in length yields a similar long-term functional outcome assessed by anginal status, exercise tolerance and myocardial perfusion.
Databáze: OpenAIRE
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