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Effects of coronary revascularization on global coronary flow reserve in stable coronary artery disease

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Please use this identifier to cite or link to this item:http://hdl.handle.net/2115/72289

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)

Submitter: 相川 忠夫

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