title: Coronary pressure measurement to determine treatment strategy for equivocal left main coronary artery lesions.
abstract: It is often hard to select a treatment strategy for equivocal left main coronary artery (LMCA) disease. We investigated the usefulness of coronary pressure (CP) measurement for determining the treatment strategy in intermediate LMCA disease. We measured CP in 15 consecutive patients with equivocal LMCA disease (age 67.6 +/- 7.5 years, 14 males). Myocardial fractional flow reserve (FFRmyo) was obtained as the ratio of CP distal to the lesion/aortic pressure under maximal coronary dilation. Patients with FFRmyo > or = 0.75 and <0.75 received medical therapy and coronary artery bypass grafting (CABG), respectively, and were followed up for 32.5 +/- 9.7 (20-47) months. Eight patients received medical therapy and 7 patients underwent CABG in accordance with the FFRmyo criteria noted above. FFRmyo of the LMCA was 0.91 +/- 0.01 and 0.61 +/- 0.03 in patients who received medical and surgical therapy, respectively. Neither reference vessel diameter, minimal lumen diameter, nor percent diameter stenosis was significantly different between patients who received medical and surgical therapy. During the follow-up period, no patients with medical therapy showed symptoms due to the LMCA lesion. Similarly, 5 of 7 patients with CABG showed improvement of symptoms and the remaining 2 patients were hospitalized with congestive heart failure. No cardiac death was recorded in the patients with medical or surgical therapy. In conclusion, the present results clearly demonstrated that CP is clinically useful for determining the treatment strategy for equivocal LMCA lesions but coronary angiography is not.
authors.affiliation: Department of Medicine and Medical Science, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan.
authors.forename: Shunji
authors.initials: S
authors.lastname: Suemaru
authors.forename: Kohichiro
authors.initials: K
authors.lastname: Iwasaki
authors.forename: Keizo
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Shozo
authors.initials: S
authors.lastname: Kusachi
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Hina
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirohata
authors.forename: Minoru
authors.initials: M
authors.lastname: Hirota
authors.forename: Masaaki
authors.initials: M
authors.lastname: Murakami
authors.forename: Shigeshi
authors.initials: S
authors.lastname: Kamikawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Murakami
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Shiratori
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology*; D006328:Cardiac Catheterization; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D003326:Coronary Circulation / Q000502:physiology*; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D003331:Coronary Vessels / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology; D012039:Regional Blood Flow / Q000502:physiology