| Prognostic value of coronary blood flow velocity and myocardial perfusion in intermediate coronary narrowings and multivessel disease. | |
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MedLine Citation:
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PMID: 11869852 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: This study aimed to investigate the roles of intracoronary derived coronary flow velocity reserve (CFVR) and myocardial perfusion scintigraphy (single photon emission computed tomography, or SPECT) for management of an intermediate lesion in patients with multivessel coronary artery disease. BACKGROUND: Evaluation of the functional significance of intermediate coronary narrowings (40% to 70% diameter stenosis) is important for clinical decision making and risk stratification. METHODS: In a prospective, multicenter study, SPECT was performed in 191 patients with stable angina and multivessel disease and scheduled for angioplasty (percutaneous transluminal coronary angioplasty, or PTCA) of a severe coronary narrowing. Coronary flow velocity reserve was determined selectively distal to an intermediate lesion in another artery using a Doppler guidewire. Percutaneous transluminal coronary angioplasty of the intermediate lesion was deferred when SPECT was negative or CFVR greater-than-or-equal 2.0. Patients were followed for one year to document major cardiac events (death, infarction, revascularization), related to the intermediate lesion. RESULTS: Reversible perfusion defects were documented in the area of the intermediate lesion in 30 (16%) patients; CFVR was positive in 46 (24%) patients. Percutaneous transluminal coronary angioplasty of the intermediate lesion was deferred in 182 patients. During follow-up, 19 events occurred (3 myocardial infarctions, 16 revascularizations). Coronary flow velocity reserve was a more accurate predictor of cardiac events than was SPECT; relative risk: CFVR 3.9 (1.7 to 9.1), p < 0.05; SPECT 0.5 (0.1 to 3.2), p = NS. Multivariate analysis revealed CFVR as the only significant predictor for cardiac events. CONCLUSIONS: Deferral of PTCA of intermediate lesions in multivessel disease is safe when CFVR greater-than-or-equal 2.0 (event rate 6%). This selective evaluation of coronary lesion severity during cardiac catheterization allows a more accurate risk stratification than does SPECT, which is important for clinical decision making in this patient cohort. |
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Authors:
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Steven A J Chamuleau; Rene A Tio; Carel C de Cock; Ebo D de Muinck; Nico H J Pijls; Berthe L F van Eck-Smit; Karel T Koch; Martijn Meuwissen; Marcel G W Dijkgraaf; Angelina de Jong; Hein J Verberne; Rob A M van Liebergen; Gert Jan Laarman; Jan G P Tijssen; Jan J Piek |
Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 39 ISSN: 0735-1097 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 2002 Mar |
Date Detail:
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Created Date: 2002-02-28 Completed Date: 2002-03-20 Revised Date: 2010-03-23 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 852-8 Citation Subset: AIM; IM |
Affiliation:
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Departments of Cardiology, Academic Medical Center-University of Amsterdam, The Netherlands. s.a.chamuleau@amc.uva.nl |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Angioplasty, Transluminal, Percutaneous Coronary* Blood Flow Velocity / physiology Coronary Artery Disease / physiopathology*, radionuclide imaging*, therapy Coronary Circulation / physiology* Coronary Stenosis / physiopathology*, radionuclide imaging*, therapy Female Heart Catheterization Humans Male Middle Aged Prognosis Prospective Studies Severity of Illness Index Tomography, Emission-Computed, Single-Photon* Treatment Outcome |
| Comments/Corrections | |
Comment In:
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J Am Coll Cardiol. 2002 Mar 6;39(5):859-63
[PMID:
11869853
]
J Am Coll Cardiol. 2002 Aug 7;40(3):573 [PMID: 12142129 ] |
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