HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Markus K. Fritz Axel M. Laczkovics Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lindstaedt, M. Articles by Bojara, W. Search for Related Content PubMed PubMed Citation Articles by Lindstaedt, M. Articles by Bojara, W. Related Collections Cardiac - physiology Coronary disease

J Thorac Cardiovasc Surg 2005;129:897-903
© 2005 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Optimizing revascularization strategies in patients with multivessel coronary disease: Impact of intracoronary pressure measurements

^a Medical Clinic II, University Hospital Bergmannsheil, Bochum, Germany
^b Division of Cardiothoracic Surgery, University Hospital Bergmannsheil, Bochum, Germany
^c Institute of High Frequency Engineering, Ruhr-University-Bochum, Bochum, Germany

Received for publication July 10, 2004; revisions received August 23, 2004; accepted for publication August 27, 2004.

^_* Address for reprints: Michael Lindstaedt, MD, Medizinische Klinik II, Universitä tsklinik Bergmannsheil, Ruhr-Universitä t Bochum, Buerkle-de-la-Camp-Platz 1, 44789 Bochum, Germany. (E-mail: michael.lindstaedt{at}ruhr-uni-bochum.de).

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 µg·kg^–1·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.

This article has been cited by other articles:

				M. J. Kern and H. Samady Current Concepts of Integrated Coronary Physiology in the Catheterization Laboratory J. Am. Coll. Cardiol., January 19, 2010; 55(3): 173 - 185. [Abstract] [Full Text] [PDF]