TY - JOUR
T1 - Prognostic value of coronary blood flow velocity and myocardial perfusion in intermediate coronary Narrowings and multivessel disease
AU - Chamuleau, Steven A. J.
AU - Tio, Rene A.
AU - de Cock, Carel C.
AU - de Muinck, Ebo D.
AU - Pijls, Nico H. J.
AU - van Eck-Smit, Berthe L. F.
AU - Koch, Karel T.
AU - Meuwissen, Martijn
AU - Dijkgraaf, Marcel G. W.
AU - de Jong, Angelina
AU - Verberne, Hein J.
AU - van Liebergen, Rob A. M.
AU - Laarman, Gert Jan
AU - Tijssen, Jan G. P.
AU - Piek, Jan J.
PY - 2002
Y1 - 2002
N2 - 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 patient, 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 to2.0. 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 to2.0 (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. (C) 2002 by the American College of Cardiology Foundation
AB - 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 patient, 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 to2.0. 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 to2.0 (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. (C) 2002 by the American College of Cardiology Foundation
U2 - https://doi.org/10.1016/S0735-1097(01)01821-6
DO - https://doi.org/10.1016/S0735-1097(01)01821-6
M3 - Article
C2 - 11869852
SN - 0735-1097
VL - 39
SP - 852
EP - 858
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 5
ER -