title: Coronary pressure measurement identifies patients with diffuse coronary artery disease who benefit from coronary revascularization.
abstract: OBJECTIVE
  We analyzed the pressure drop pattern in patients with diffuse coronary artery disease and treated these patients according to their pressure drop pattern.
  
  
  METHODS
  We measured pullback coronary pressure from the distal to the proximal left anterior descending coronary artery in 83 patients with diffuse coronary artery disease. Coronary pressure pattern was divided into two types: the abrupt and gradual pressure drop patterns. Patients with an abrupt pressure drop pattern and fractional flow reserve less than 0.75 underwent coronary revascularization. Patients with gradual pressure drop pattern received medical therapy except five patients, who underwent coronary bypass surgery because of triple vessel disease. We followed these patients for 8-20 (14.3±4.6) months using the grading system of the Canadian Cardiovascular Society (CCS grade).
  
  
  RESULTS
  Abrupt pressure drop pattern was observed in 47 patients, whereas the remaining 36 patients showed gradual pressure drop pattern. Angiographic findings did not distinguish these pressure drop patterns. All patients with the abrupt pressure drop pattern except one showed symptomatic improvement (the CCS grade decreased from 2.64±0.76 to 1.09±0.35, P<0.01) in response to coronary revascularization. In patients with the gradual pressure drop pattern, 17 of 36 patients showed improvement of symptoms (the CCS grade decreased from 2.31±0.53 to 1.75±0.77, P<0.01).
  
  
  CONCLUSIONS
  Coronary pressure measurement distinguished patients with abrupt pressure drop pattern from those with gradual pressure drop pattern, and the former group of patients benefited from coronary revascularization.
authors.affiliation: Department of Cardiology, Okayama Kyokuto Hospital, Nakaku, Okayama, Japan. kiwasaki@kyokuto.or.jp
authors.forename: Kohichiro
authors.initials: K
authors.lastname: Iwasaki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Matsumoto
mesh_terms: D000368:Aged; D001794:Blood Pressure; D006328:Cardiac Catheterization; D002317:Cardiovascular Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D003326:Coronary Circulation; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents