Effect of permanent right internal mammary artery occlusion on right coronary artery supply: A randomized placebo-controlled clinical trial
| Autor: | Raphael Grossenbacher, Marius Reto Bigler, Michael Stoller, Christine Tschannen, Christian Seiler |
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| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
Cardiac Catheterization medicine.medical_specialty Myocardial Ischemia Collateral Circulation Blood Pressure 610 Medicine & health Coronary Artery Disease Equivalence Trials as Topic 030204 cardiovascular system & hematology Coronary Angiography Angina Pectoris Placebos Coronary artery disease Angina Electrocardiography 03 medical and health sciences Coronary circulation 0302 clinical medicine Double-Blind Method Coronary Circulation medicine.artery Internal medicine Occlusion medicine Humans Prospective Studies 030212 general & internal medicine cardiovascular diseases Mammary Arteries Aged business.industry Central venous pressure Balloon Occlusion medicine.disease Collateral circulation Coronary Vessels medicine.anatomical_structure Coronary occlusion Right coronary artery Chronic Disease Cardiology Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Bigler, Marius R.; Stoller, Michael; Tschannen, Christine; Grossenbacher, Raphael; Seiler, Christian (2020). Effect of permanent right internal mammary artery occlusion on right coronary artery supply: A randomized placebo-controlled clinical trial. American Heart Journal, 230, pp. 1-12. Elsevier 10.1016/j.ahj.2020.09.006 |
| DOI: | 10.1016/j.ahj.2020.09.006 |
| Popis: | Background Natural, nonsurgical internal mammary artery (IMA) bypasses to the coronary circulation have been shown to function as extracardiac sources of myocardial blood supply. The goal of this randomized, placebo-controlled, double-blind trial was to test the efficacy of permanent right IMA (RIMA) device occlusion on right coronary artery (RCA) occlusive blood supply and on clinical and electrocardiographic (ECG) signs of myocardial ischemia. Methods This was a prospective superiority trial in 100 patients with chronic coronary artery disease randomly allocated (1:1) to RIMA vascular device occlusion (verum group) or to RIMA sham procedure (placebo group). The primary study end point was RCA collateral flow index (CFI) as obtained during a 1-minute ostial RCA balloon occlusion at baseline before and at follow-up examination 6 weeks after the trial intervention. CFI is the ratio between simultaneous mean coronary occlusive divided by mean aortic pressure both subtracted by central venous pressure. Simultaneously obtained secondary study end points were the registration of angina pectoris and quantitative intracoronary ECG ST-segment shift. Results CFI change during the follow-up period was +0.036 ± 0.068 in the verum group and −0.021 ± 0.097 in the placebo group (P = .0011). Angina pectoris during the same RCA balloon occlusions had disappeared at follow-up in 14/49 patients of the verum group and in 4/49 patients of the placebo group (P = .0091). Simultaneous intracoronary ECG ST-segment shift change revealed diminished myocardial ischemia at follow-up in the verum group and more severe ischemia in the placebo group. Conclusions Permanent RIMA device occlusion augments RCA supply to the effect of diminishing clinical and electrocardiographic signs of myocardial ischemia during a brief controlled coronary occlusion. |
| Databáze: | OpenAIRE |
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