| Title: | Effects of coronary revascularization on global coronary flow reserve in stable coronary artery disease |
| Authors: | Aikawa, Tadao Browse this author →KAKEN DB |
| Naya, Masanao Browse this author →KAKEN DB |
| Obara, Masahiko Browse this author |
| Manabe, Osamu Browse this author →KAKEN DB |
| Magota, Keiichi Browse this author →KAKEN DB |
| Koyanagawa, Kazuhiro Browse this author |
| Asakawa, Naoya Browse this author |
| Ito, Yoichi M. Browse this author →KAKEN DB |
| Shiga, Tohru Browse this author →KAKEN DB |
| Katoh, Chietsugu Browse this author →KAKEN DB |
| Anzai, Toshihisa Browse this author →KAKEN DB |
| Tsutsui, Hiroyuki Browse this author →KAKEN DB |
| Murthy, Venkatesh L. Browse this author |
| Tamaki, Nagara Browse this author →KAKEN DB |
| Keywords: | Coronary artery disease |
| Coronary flow reserve |
| Percutaneous coronary intervention |
| Coronary artery bypass grafting |
| 15O-water positron emission tomography |
| Issue Date: | 1-Jan-2019 |
| Publisher: | Oxford University Press |
| Journal Title: | Cardiovascular Research |
| Volume: | 115 |
| Issue: | 1 |
| Start Page: | 119 |
| End Page: | 129 |
| Publisher DOI: | 10.1093/cvr/cvy169 |
| PMID: | 29992275 |
| Abstract: | Aims: Coronary flow reserve (CFR) is an integrated measure of the entire coronary vasculature, and is a powerful prognostic marker in coronary artery disease (CAD). The extent to which coronary revascularization can improve CFR is unclear. This study aimed to evaluate the impact of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) on CFR in patients with stable CAD. Methods and results: In a prospective, multicentre observational study, CFR was measured by 15O-water positron emission tomography as the ratio of stress to rest myocardial blood flow at baseline and 6 months after optimal medical therapy (OMT) alone, PCI, or CABG. Changes in the SYNTAX and Leaman scores were angiographically evaluated as indicators of completeness of revascularization. Follow-up was completed by 75 (25 OMT alone, 28 PCI, and 22 CABG) out of 82 patients. The median SYNTAX and Leaman scores, and baseline CFR were 14.5 [interquartile range (IQR): 8-24.5], 5.5 (IQR: 2.5-12.5), and 1.94 (IQR: 1.67-2.66), respectively. Baseline CFR was negatively correlated with the SYNTAX (ρ = -0.40, P < 0.001) and Leaman scores (ρ = -0.33, P = 0.004). Overall, only CABG was associated with a significant increase in CFR [1.67 (IQR: 1.14-1.96) vs. 1.98 (IQR: 1.60-2.39), P < 0.001]. Among patients with CFR <2.0 (n = 41), CFR significantly increased in the PCI [1.70 (IQR: 1.42-1.79) vs. 2.21 (IQR: 1.78-2.49), P = 0.002, P < 0.001 for interaction between time and CFR] and CABG groups [1.28 (IQR: 1.13-1.80) vs. 1.86 (IQR: 1.57-2.22), P < 0.001]. The reduction in SYNTAX or Leaman scores after PCI or CABG was independently associated with the percent increase in CFR after adjusting for baseline characteristics (P = 0.012 and P = 0.011, respectively). Conclusion: Coronary revascularization ameliorated reduced CFR in patients with obstructive CAD. The degree of improvement in angiographic CAD burden by revascularization was correlated with magnitude of improvement in CFR. |
| Rights: | http://creativecommons.org/licenses/by-nc/4.0/ |
| Type: | article |
| URI: | http://hdl.handle.net/2115/72289 |
| Appears in Collections: | 北海道大学病院 (Hokkaido University Hospital) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)
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