CLINICAL OUTCOME OF DEFERRING ANGIOPLASTY IN PATIENTS WITH NORMAL TRANSLESIONAL PRESSURE-FLOW VELOCITY-MEASUREMENTS

Citation
Mj. Kern et al., CLINICAL OUTCOME OF DEFERRING ANGIOPLASTY IN PATIENTS WITH NORMAL TRANSLESIONAL PRESSURE-FLOW VELOCITY-MEASUREMENTS, Journal of the American College of Cardiology, 25(1), 1995, pp. 178-187
Citations number
42
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiac & Cardiovascular System
ISSN journal
0735-1097
Volume
25
Issue
1
Year of publication
1995
Pages
178 - 187
Database
ISI
SICI code
0735-1097(1995)25:1<178:COODAI>2.0.ZU;2-H
Abstract
Objectives. The objective of this study was to determine the feasibili ty, safety and outcome of deferring angioplasty in patients with angio graphically intermediate lesions that are found not to limit how, as d etermined by direct translesional hemodynamic assessment. Background. The clinical importance of some coronary stenoses of intermediate angi ographic severity frequently requires noninvasive stress testing. Dire ct translesional pressure and flow measurements may assist in clinical decision making in patients with such stenoses. Methods. Translesiona l spectral flow velocity (Doppler guide wire) and pressure data were o btained in 88 patients for 100 lesions (26 single-vessel and 74 multiv essel coronary artery lesions) with quantitative angiographic coronary narrowings (mean +/- SD diameter narrowing 54 +/- 7% [range 40% to 74 %]). Target lesion angioplasty was prospectively deferred on the basis of predetermined normal values, defined as a proximal/distal velocity ratio <1.7 or a pressure gradient <25 mm Hg, or both. Patients were f ollowed up for 9 +/- 5 months (range 6 to 30). Results. In the deferre d angioplasty group, translesional velocity ratios, were similar to th ose of a normal reference group (mean 1.1 +/- 0.32 vs. 13 +/- 0.55) an d significantly lower than those of a reference cohort of patients who had undergone angioplasty (2.27 +/- 1.2, p < 0.05). The mean transles ional pressure gradient in the deferred angioplasty group was also low er than that in the angioplasty group (10 +/- 9 vs, 45 +/- 22 mm Hg, p < 0.001). At follow-up in the deferred angioplasty group, four, six, zero and two patients, respectively, had had subsequent angioplasty, c oronary artery bypass graft surgery or myocardial infarction or had di ed. In one patient, death was related to angioplasty of a nontarget ar tery lesion, and one patient with multivessel disease had a cardiac ar rest due to ventricular fibrillation 12 months after lesion assessment . Among the 10 patients requiring later angioplasty or coronary artery bypass grafting, only six procedures were performed on target arterie s. No patient had a complication of translesional flow or pressure mea surements. Conclusions. These data demonstrate the safety, feasibility and clinical outcome of deferring angioplasty of coronary artery narr owings associated with normal translesional coronary hemodynamic varia bles. Given the practice of performing angioplasty without ischemic te sting or when testing is inconclusive, translesional hemodynamic data obtained at diagnostic catheterization can identify patients in whom i t is safe to postpone angioplasty.