Optimizing revascularization strategies in patients with multivessel coronary disease: impact of intracoronary pressure measurements.
OBJECTIVE
In patients with multivessel coronary disease, the functional significance of each lesion is often unclear, and preinterventional stress tests may be inconclusive. In this setting, intracoronary pressure measurements may be helpful to define the optimal revascularization strategy.


METHODS
Twenty-five consecutive patients (aged 64 +/- 11 years) with multivessel disease, inconclusive stress tests or not performed stress tests, and an angiographically intermediate coronary artery stenosis in at least 1 major vessel underwent intracoronary pressure measurements. Myocardial fractional flow reserve was measured for the intermediate lesions under the condition of maximum hyperemia induced by intravenous adenosine (140 microg x kg(-1) x min(-1). Revascularization strategies based on angiographic information alone were compared with treatment strategies based on fractional flow reserve results.


RESULTS
The original recommendation of the revascularization procedure of choice (bypass operation or angioplasty) was changed in 9 patients (36%) on the basis of the results of fractional flow reserve measurements. In 6 more patients, pressure measurements led to a change in the recommended number of anastomoses to be aimed for during the operation. Within diffusely diseased vessels, fractional flow reserve provided an exact segmental resolution of pathologic vessel resistance for optimal graft placement. Significant left main disease was confirmed in 3 of 6 patients and was detected in 3 angiographically unsuspected cases.


CONCLUSIONS
In patients with multivessel disease, coronary pressure-derived fractional flow reserve is a valuable tool to guide clinical decision making and support cardiologists and cardiovascular surgeons in the composition of optimal revascularization strategies.
Lindstaedt
Michael
M
Medical Clinic II, University HospitalBergmannsheil, Bochum, Germany. michael.lindstaedt@ruhr-uni-bochum.de
Fritz
Markus K
MK
Yazar
Aydan
A
Perrey
Christian
C
Germing
Alfried
A
Grewe
Peter H
PH
Laczkovics
Axel M
AM
Mügge
Andreas
A
Bojara
Waldemar
W
D000241:Adenosine; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D015906:Angioplasty, Balloon, Coronary; D001794:Blood Pressure / Q000502:physiology*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003326:Coronary Circulation / Q000502:physiology*; D023921:Coronary Stenosis / Q000503:physiopathology / Q000601:surgery*; D003331:Coronary Vessels / Q000473:pathology / Q000503:physiopathology*; D003657:Decision Making; D005080:Exercise Test; D005260:Female; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D010347:Patient Care Planning; D011446:Prospective Studies; D016037:Single-Blind Method
D000241:Adenosine