title: Impact of functional focal versus diffuse coronary artery disease on bypass graft patency.
abstract: BACKGROUND
  Pressure guidewire pullback recording can differentiate between functional focal and diffuse disease types in coronary artery disease. The aim of this study was to compare the outcome of coronary artery bypass graft (CABG) patency between patients with functional focal versus diffuse disease types in recipient coronary arteries.
  
  
  RESULTS
  We investigated 89 patients who underwent pressure guidewire pullback in the left anterior descending (LAD) artery before CABG using internal mammary artery (IMA). Based on the pressure guidewire pullback data, the LAD lesions were classified into functional focal disease (abrupt pressure step-up; n=58) or functional diffuse disease (gradual pressure increase; n=31). Follow-up computed tomography (CT) angiography was conducted within 1year after CABG to assess the bypass graft patency. Pre CABG, LAD angiographic percent diameter stenosis (57±10% vs. 54±12%, p=0.228) and fractional flow reserve (FFR) (0.68±0.07 vs. 0.69±0.07, p=0.244) were not different between the functional focal and diffuse disease groups. The CABG procedure characteristics were similarly comparable between the two groups. In the follow-up CT angiography after CABG, occlusion or string sign of the IMA graft to LAD was more frequently observed in the functional diffuse disease group than in the functional focal disease group (26% vs. 7%, p=0.021).
  
  
  CONCLUSIONS
  In CABG, functional diffuse disease in the recipient coronary artery was associated with an increased risk of the graft failure in comparison with functional focal disease.
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Yasutsugu
authors.initials: Y
authors.lastname: Shiono
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan. Electronic address: takakubo@wakayama-med.ac.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kubo
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Honda
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Katayama
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Aoki
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Satogami
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Kuninobu
authors.initials: K
authors.lastname: Kashiyama
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Taruya
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Nishiguchi
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Kuroi
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Orii
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Takeyoshi
authors.initials: T
authors.lastname: Kameyama
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamano
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Yamaguchi
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Matsuo
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ino
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Tanaka
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hozumi
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama, Japan.
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Nishimura
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Okamura
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Akasaka
mesh_terms: D000368:Aged; D000072226:Computed Tomography Angiography / Q000379:methods; D017023:Coronary Angiography / Q000379:methods; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D005260:Female; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology; D006083:Graft Occlusion, Vascular / Q000175:diagnosis* / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D018570:Risk Assessment; D012720:Severity of Illness Index; D058017:Vascular Grafting / Q000009:adverse effects / Q000379:methods; D014654:Vascular Patency
keywords: Coronary artery bypass graft; Coronary artery disease; Fractional flow reserve