Abstract
It is often hard to select a treatment strategy for equivocal left main coronary artery (LMCA) disease. We investigated the usefulness of coronary pressure (CP) measurement for determining the treatment strategy in intermediate LMCA disease. We measured CP in 15 consecutive patients with equivocal LMCA disease (age 67.6 ± 7.5 years, 14 males). Myocardial fractional flow reserve (FFRmyo) was obtained as the ratio of CP distal to the lesion/aortic pressure under maximal coronary dilation. Patients with FFRmyo ≥0.75 and <0.75 received medical therapy and coronary artery bypass grafting (CABG), respectively, and were followed up for 32.5 ± 9.7 (20–47) months. Eight patients received medical therapy and 7 patients underwent CABG in accordance with the FFRmyo criteria noted above. FFRmyo of the LMCA was 0.91 ± 0.01 and 0.61 ± 0.03 in patients who received medical and surgical therapy, respectively. Neither reference vessel diameter, minimal lumen diameter, nor percent diameter stenosis was significantly different between patients who received medical and surgical therapy. During the follow-up period, no patients with medical therapy showed symptoms due to the LMCA lesion. Similarly, 5 of 7 patients with CABG showed improvement of symptoms and the remaining 2 patients were hospitalized with congestive heart failure. No cardiac death was recorded in the patients with medical or surgical therapy. In conclusion, the present results clearly demonstrated that CP is clinically useful for determining the treatment strategy for equivocal LMCA lesions but coronary angiography is not.
Article PDF
Similar content being viewed by others
Explore related subjects
Discover the latest articles, news and stories from top researchers in related subjects.Avoid common mistakes on your manuscript.
References
PJ de Feyter PW Serruys (1984) ArticleTitleThrombolysis of acute total occlusion of the left main coronary artery in evolving myocardial infarction Am J Cardiol 53 1727–1728 Occurrence Handle6731318 Occurrence Handle1:STN:280:BiuB38fis1Y%3D
S Goldberg W Grossman JE Markis MV Cohen HA Baltaxe DC Levin (1978) ArticleTitleTotal occlusion of the left main coronary artery. A clinical, hemodynamic and angiographic profile Am J Med 64 3–8 Occurrence Handle623135 Occurrence Handle1:STN:280:CSeC3c%2Fms1E%3D Occurrence Handle10.1016/0002-9343(78)90173-0
DE Ward H Valantine W Hui (1983) ArticleTitleOccluded left main stem coronary artery. Report of five patients and review of published reports Br Heart J 49 276–279 Occurrence Handle6830663 Occurrence Handle1:STN:280:BiyC2Mzjslc%3D
K Iwasaki S Kusachi K Hina O Nishiyama J Kondo T Kita T Hata G Taniguchi T Tsuji (1993) ArticleTitleAcute left main coronary artery obstruction with myocardial infarction – reperfusion strategies, and the clinical and angiographic outcome Jpn Circ J 57 891–897 Occurrence Handle8371482 Occurrence Handle1:STN:280:ByyA1c7pslw%3D
Y Sato F Inoue A Yoshimura T Fukui T Imazeki M Kato H Ono S Yoda M Mitsui N Matsumoto S Furuhashi M Takahashi K Kanmatsuse (2003) ArticleTitleRegression of an atherosclerotic coronary artery plaque demonstrated by multislice spiral computed tomography in a patient with stable angina pectoris Heart Vessels 18 224–226 Occurrence Handle14520493
Y Itani S Sone T Nakayama T Suzuki S Watanabe K Ito S Takashima H Fushimi H Sanada (2004) ArticleTitleCoronary artery calcification detected by a mobile helical computed tomography unit and future cardiovascular death: 4-year follow-up of 6120 asymptomatic Japanese Heart Vessels 19 161–163 Occurrence Handle15278387 Occurrence Handle10.1007/s00380-003-0759-z
JB Hermiller JT Cusma LA Spero DF Fortin MB Harding TM Bashore (1992) ArticleTitleQuantitative and qualitative coronary angiographic analysis: review of methods, utility, and limitations Cathet Cardiovasc Diagn 25 110–131 Occurrence Handle1544153 Occurrence Handle1:STN:280:By2C1czhs1A%3D
PW Johnston S Fort EA Cohen (1999) ArticleTitleNoncritical disease of the left main coronary artery: limitations of angiography and the role of intravascular ultrasound Can J Cardiol 15 297–302 Occurrence Handle10202193 Occurrence Handle1:STN:280:DyaK1M3itFKitA%3D%3D
A Cameron HG Kemp SuffixJr LD Fisher A Gosselin MP Judkins JW Kennedy J Lesperance JG Mudd TJ Ryan JF Silverman F Tristani RE Vlietstra LF Wexler (1983) ArticleTitleLeft main coronary artery stenosis: angiographic determination Circulation 68 484–489 Occurrence Handle6872161 Occurrence Handle1:STN:280:BiyB2Mbmt1c%3D
M Yamagishi Y Hongo Y Goto T Umeno H Tsutsui T Asanuma K Miyatake (1996) ArticleTitleIntravascular ultrasound evidence of angiographically undetected left main coronary artery disease and associated trauma during interventional procedures Heart Vessels 11 262–268 Occurrence Handle9129247 Occurrence Handle1:STN:280:ByiB2srjslQ%3D Occurrence Handle10.1007/BF01746207
S Nanto K Nishida A Hirayama M Mishima K Komamura M Masai T Sakakibara K Kodama (1993) ArticleTitleSupported angioplasty with synchronized retroperfusion in high-risk patients with left main trunk or near left main trunk obstruction Am Heart J 125 301–309 Occurrence Handle8427120 Occurrence Handle1:STN:280:ByyC2M7htVQ%3D Occurrence Handle10.1016/0002-8703(93)90004-S
S Nanto K Kodama M Mishima K Komamura S Asada M Inoue (1990) ArticleTitlePercutaneous transluminal coronary angioplasty using kissing balloon technique in the left main trunk Heart Vessels 5 107–112 Occurrence Handle2354985 Occurrence Handle1:STN:280:By%2BB1crhtFA%3D Occurrence Handle10.1007/BF02058327
D Saba S Ener M Bicer A Kan SuffixII I Senkaya H Ozkan (2004) ArticleTitleOff-pump bypass grafting in patients with significant left main coronary artery stenosis Heart Vessels 19 8–12 Occurrence Handle14685748 Occurrence Handle10.1007/s00380-003-0717-9
NH Pijls B Van Gelder P Van der Voort K Peels FA Bracke HJ Bonnier MI el Gamal (1995) ArticleTitleFractional flow reserve. A useful index to evaluate the influence of an epicardial coronary stenosis on myocardial blood flow Circulation 92 3183–3193 Occurrence Handle7586302 Occurrence Handle1:STN:280:BymD1c%2FgslQ%3D
NH Pijls B De Bruyne K Peels PH Van Der Voort HJ Bonnier JKJJ Bartunek JJ Koolen (1996) ArticleTitleMeasurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses N Engl J Med 334 1703–1708 Occurrence Handle8637515 Occurrence Handle1:STN:280:BymB2c%2FltlU%3D Occurrence Handle10.1056/NEJM199606273342604
NHJ Pijls B De Bruyne (2000) Coronary pressure EditionNumber2nd edn. Kluwer Academic Dordrecht 268–269
GJ Bech H Droste NH Pijls B De Bruyne JJ Bonnier HR Michels KH Peels JJ Koolen (2001) ArticleTitleValue of fractional flow reserve in making decisions about bypass surgery for equivocal left main coronary artery disease Heart 86 547–552 Occurrence Handle11602550 Occurrence Handle1:STN:280:DC%2BD3MrlsFOktA%3D%3D Occurrence Handle10.1136/heart.86.5.547
M Jimenez-Navarro JM Hernandez-Garcia JH Alonso-Briales B Kuhlmorgen JJ Gomez-Doblas JM Garcia-Pinilla R Lopez-Salguero T Galvan Ede (2004) ArticleTitleShould we treat patients with moderately severe stenosis of the left main coronary artery and negative FFR results? J Invas Cardiol 16 398–400
MA Leesar R Masden V Jasti (2004) ArticleTitlePhysiological and intravascular ultrasound assessment of an ambiguous left main coronary artery stenosis Catheter Cardiovasc Interv 62 349–357 Occurrence Handle15224304
PA Doriot PA Dorsaz L Dorsaz P Chatelain W Rutishauser (1996) ArticleTitleThe impact of vessel orientation in space on densitometric measurements of cross sectional areas of coronary arteries Int J Card Imaging 12 289–297 Occurrence Handle8993991 Occurrence Handle1:STN:280:ByiC2cjhtlE%3D Occurrence Handle10.1007/BF01797742
C Di Mario J Haase A den Boer JH Reiber PW Serruys (1992) ArticleTitleEdge detection versus densitometry in the quantitative assessment of stenosis phantoms: an in vivo comparison in porcine coronary arteries Am Heart J 124 1181–1189 Occurrence Handle1442484 Occurrence Handle1:STN:280:ByyD2s7mt1A%3D
TC Gerber R Erbel G Gorge J Ge HJ Rupprecht J Meyer (1994) ArticleTitleExtent of atherosclerosis and remodeling of the left main coronary artery determined by intravascular ultrasound Am J Cardiol 73 666–671 Occurrence Handle8166063 Occurrence Handle1:STN:280:ByuB3MbjvVY%3D Occurrence Handle10.1016/0002-9149(94)90931-8
H Hashimoto T Isshiki Y Ikari K Hara F Saeki T Tamura T Yamaguchi H Suma (1996) ArticleTitleEffects of competitive blood flow on arterial graft patency and diameter. Medium-term postoperative follow-up J Thorac Cardiovasc Surg 111 399–407 Occurrence Handle8583813 Occurrence Handle1:STN:280:BymC28%2Fot1M%3D
AS Abizaid GS Mintz A Abizaid R Mehran AJ Lansky AD Pichard LF Satler H Wu KM Kent MB Leon (1999) ArticleTitleOne-year follow-up after intravascular ultrasound assessment of moderate left main coronary artery disease in patients with ambiguous angiograms J Am Coll Cardiol 34 707–715 Occurrence Handle10483951 Occurrence Handle1:STN:280:DyaK1MvhtFOmsA%3D%3D Occurrence Handle10.1016/S0735-1097(99)00261-2
R Sukhija K Yalamanchili WS Aronow (2003) ArticleTitlePrevalence of left main coronary artery disease, of three- or four-vessel coronary artery disease, and of obstructive coronary artery disease in patients with and without peripheral arterial disease undergoing coronary angiography for suspected coronary artery disease Am J Cardiol 92 304–305 Occurrence Handle12888139 Occurrence Handle10.1016/S0002-9149(03)00632-5
B De Bruyne NH Pijls J Bartunek K Kulecki JW Bech H De Winter P Van Crombrugge GR Heyndrickx W Wijns (2001) ArticleTitleFractional flow reserve in patients with prior myocardial infarction Circulation 104 157–162 Occurrence Handle11447079 Occurrence Handle1:STN:280:DC%2BD3Mzpt1Kqtw%3D%3D
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Suemaru, S., Iwasaki, K., Yamamoto, K. et al. Coronary pressure measurement to determine treatment strategy for equivocal left main coronary artery lesions. Heart Vessels 20, 271–277 (2005). https://doi.org/10.1007/s00380-005-0849-1
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s00380-005-0849-1