| Optimizing revascularization strategies in patients with multivessel coronary disease: impact of intracoronary pressure measurements. | |
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MedLine Citation:
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PMID: 15821661 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: 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. |
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Authors:
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Michael Lindstaedt; Markus K Fritz; Aydan Yazar; Christian Perrey; Alfried Germing; Peter H Grewe; Axel M Laczkovics; Andreas Mügge; Waldemar Bojara |
Publication Detail:
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Type: Case Reports; Comparative Study; Journal Article |
Journal Detail:
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Title: The Journal of thoracic and cardiovascular surgery Volume: 129 ISSN: 0022-5223 ISO Abbreviation: J. Thorac. Cardiovasc. Surg. Publication Date: 2005 Apr |
Date Detail:
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Created Date: 2005-04-11 Completed Date: 2005-05-19 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0376343 Medline TA: J Thorac Cardiovasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 897-903 Citation Subset: AIM; IM |
Affiliation:
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Medical Clinic II, University HospitalBergmannsheil, Bochum, Germany. michael.lindstaedt@ruhr-uni-bochum.de |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adenosine
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diagnostic use Adult Aged Anastomosis, Surgical Angioplasty, Transluminal, Percutaneous Coronary Blood Pressure / physiology* Coronary Angiography Coronary Artery Bypass Coronary Circulation / physiology* Coronary Stenosis / physiopathology, surgery* Coronary Vessels / pathology, physiopathology* Decision Making Exercise Test Female Humans Hyperemia / physiopathology Male Middle Aged Myocardial Revascularization / methods* Patient Care Planning* Prospective Studies Single-Blind Method |
| Chemical | |
Reg. No./Substance:
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58-61-7/Adenosine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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