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Sugimoto K, Takahashi K, Okune M, Ueno M, Fujita T, Doi H, Tobaru T, Takanashi S, Kinoshita Y, Okawa Y, Fuku Y, Komiya T, Tsujita K, Fukui T, Shimokawa T, Watanabe Y, Kozuma K, Sakaguchi G, Nakazawa G. Impact of quantitative flow ratio on graft function in patients undergoing coronary artery bypass grafting. Cardiovasc Interv Ther 2023; 38:406-413. [PMID: 37017900 DOI: 10.1007/s12928-023-00929-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/17/2023] [Indexed: 04/06/2023]
Abstract
Recent studies showed that preoperative functional assessment with fractional flow reserve (FFR) could predict a long-term patency of arterial bypass grafts in patients with coronary artery bypass grafting (CABG). Quantitative flow ratio (QFR) is a novel angiography-based approach to estimate FFR. This study aimed to investigate whether preoperative QFR could discriminate arterial bypass function at 1 year after surgery. The PRIDE-METAL registry was a prospective, multicenter observational study that enrolled 54 patients with multivessel coronary artery disease. By protocol, left coronary stenoses were revascularized by CABG with arterial grafts, whereas right coronary stenoses were treated with coronary stenting. Follow-up angiography at 1 year after surgery was scheduled to assess arterial graft patency. QFR was performed using index angiography by certified analysts, blinded to bypass graft function. The primary end point of this sub-study was the discriminative ability of QFR for arterial graft function, as assessed by receiver-operating characteristic curve. Among 54 patients enrolled in the PRIDE-METAL registry, index and follow-up angiography was available in 41 patients with 97 anastomoses. QFR were analyzed in 35 patients (71 anastomoses) with an analyzability of 85.5% (71/83). Five bypass grafts were found to be non-functional at 1 year. The diagnostic performance of QFR was substantial (area under the curve: 0.89; 95% confidence interval: 0.83 to 0.96) with an optimal cutoff of 0.76 to predict functionality of bypass grafts. Preoperative QFR is highly discriminative for predicting postoperative arterial graft function.Trial registration: Clinical.gov reference: NCT02894255.
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Affiliation(s)
- Keishiro Sugimoto
- Department of Cardiology, Kindai University Faculty of Medicine, 377-2, Onohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Kuniaki Takahashi
- Department of Cardiology, Kindai University Faculty of Medicine, 377-2, Onohigashi, Osakasayama, Osaka, 589-8511, Japan.
| | - Mana Okune
- Department of Cardiology, Kindai University Faculty of Medicine, 377-2, Onohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Masafumi Ueno
- Department of Cardiology, Kindai University Faculty of Medicine, 377-2, Onohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Tsutomu Fujita
- Department of Cardiology, Sapporo Cardiovascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | - Hirosato Doi
- Department of Cardiovascular Surgery, Sapporo Cardiovascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | - Tetsuya Tobaru
- Department of Cardiology, Sakakibara Heart Insutitute, Tokyo, Japan
| | - Shuichiro Takanashi
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
| | - Yoshihisa Kinoshita
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Japan
| | - Yasuhide Okawa
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Yasushi Fuku
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Kumamoto University, Kumamoto, Japan
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Graduate School of Medicine Sciences, Kumamoto University, Kumamoto, Japan
| | - Tomoki Shimokawa
- Department of Cardiovascular Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Ken Kozuma
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Genichi Sakaguchi
- Department of Cardiovascular Surgery, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Gaku Nakazawa
- Department of Cardiology, Kindai University Faculty of Medicine, 377-2, Onohigashi, Osakasayama, Osaka, 589-8511, Japan
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2
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Mushtaq S, Gigante C, Conte E, Capovilla TM, Sonck J, Tanzilli A, Barbato E, Monizzi G, Belmonte M, De Bruyne B, Bartorelli AL, Schillaci M, Marchetti D, Carerj ML, Pontone G, Collet C, Andreini D. Preoperative angiography-derived fractional flow reserve may predict coronary artery bypass grafting occlusion and disease progression. J Cardiovasc Med (Hagerstown) 2023; 24:651-658. [PMID: 37605957 DOI: 10.2459/jcm.0000000000001509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
BACKGROUND Graft occlusion after coronary artery bypass grafting (CABG) has been associated with competitive flow of native coronary arteries. OBJECTIVES To assess with coronary computed tomography angiography (CCTA) graft occlusion and coronary artery disease (CAD) progression of native vessels after CABG and their relationship with angiography-derived vessel fractional flow reserve (vFFR) performed before surgery. METHODS Between 2006 and 2018, serial vFFR analyses were obtained before CABG in each major native coronary vessel from two institutions. All patients underwent follow-up CCTA. RESULTS In 171 consecutive patients, serial preoperative angiograms were suitable for vFFR analysis of 298 grafted and 59 nongrafted vessels. Median time between CABG and CCTA was 2.1 years. Preoperative vFFR was assessed in 131 left anterior descending artery (LAD), 132 left circumflex artery (LCX) and 94 right coronary aretry (RCA) and was less than 0.80 in 255 of 298 bypassed vessels. Graft occlusion was observed at CCTA in 28 of 298 grafts. The median preoperative vFFR value of native coronaries was higher in occluded compared with patent grafts (0.75 vs. 0.60, P < 0.001) and was associated with graft. The best vFFR cut-off to predict graft occlusion was 0.67. Progression of CAD was higher in grafted than in nongrafted vessels (89.6 vs. 47.5%, P < 0.001). Pre-CABG vFFR predicted disease progression of grafted native vessels (AUC = 0.83). CONCLUSION Preoperative vFFR derived from invasive coronary angiography was able to predict graft occlusion and CAD progression of grafted coronary arteries.
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Affiliation(s)
| | | | | | | | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples
| | | | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples
| | | | | | | | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences
| | - Matteo Schillaci
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- University of Milan, Milan
| | - Davide Marchetti
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- University of Milan, Milan
| | - Maria Ludovica Carerj
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Diagnostic and Interventional Radiology Unit, Department of Biomedical Sciences and Morphological and Functional Imaging, 'G. Martino' University Hospital Messina, Messina
| | - Gianluca Pontone
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences
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3
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Andreini D, Collet C, Leipsic J, Nieman K, Bittencurt M, De Mey J, Buls N, Onuma Y, Mushtaq S, Conte E, Bartorelli AL, Stefanini G, Sonck J, Knaapen P, Ghoshhajra B, Serruys PW. Pre-procedural planning of coronary revascularization by cardiac computed tomography: An expert consensus document of the Society of Cardiovascular Computed Tomography. EUROINTERVENTION 2022; 18:e872-e887. [PMID: 35994043 PMCID: PMC9743242 DOI: 10.4244/eij-e-22-00036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/05/2022] [Indexed: 12/12/2022]
Abstract
Coronary CT angiography (CCTA) demonstrated high diagnostic accuracy for detecting coronary artery disease (CAD) and a key role in the management of patients with low-to-intermediate pretest likelihood of CAD. However, the clinical information provided by this noninvasive method is still regarded insufficient in patients with diffuse and complex CAD and for planning percutaneous coronary intervention (PCI) and surgical revascularization procedures. On the other hand, technology advancements have recently shown to improve CCTA diagnostic accuracy in patients with diffuse and calcific stenoses. Moreover, stress CT myocardial perfusion imaging (CT-MPI) and fractional flow reserve derived from CCTA (CT-FFR) have been introduced in clinical practice as new tools for evaluating the functional relevance of coronary stenoses, with the possibility to overcome the main CCTA drawback, i.e. anatomical assessment only. The potential value of CCTA to plan and guide interventional procedures lies in the wide range of information it can provide: a) detailed evaluation of plaque extension, volume and composition; b) prediction of procedural success of CTO PCI using scores derived from CCTA; c) identification of coronary lesions requiring additional techniques (e.g., atherectomy and lithotripsy) to improve stent implantation success by assessing calcium score and calcific plaque distribution; d) assessment of CCTA-derived Syntax Score and Syntax Score II, which allows to select the mode of revascularization (PCI or CABG) in patients with complex and multivessel CAD. The aim of this Consensus Document is to review and discuss the available data supporting the role of CCTA, CT-FFR and stress CT-MPI in the preprocedural and possibly intraprocedural planning and guidance of myocardial revascularization interventions.
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Affiliation(s)
- Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | | | - Jonathon Leipsic
- St Paul's Hospital & University of British Columbia, Vancouver, British Columbia Vancouver, Canada
| | - Koen Nieman
- Stanford University School of Medicine, Departments of Medicine and Radiology, USA
| | - Marcio Bittencurt
- Division of Internal Medicine, University Hospital, University of São Paulo, São Paulo, Brazil
- DASA, São Paulo, Brazil
- Division of Cardiology and the Heart and Vascular Institute, University of Pittsburgh Medical Center
| | - Johan De Mey
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussel, Belgium
| | - Nico Buls
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussel, Belgium
| | - Yoshinobu Onuma
- Clinical Science Institute, National University of Ireland, Galway, Ireland
| | | | - Edoardo Conte
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLVZ Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Paul Knaapen
- Vrije Universiteit Medical Center, Amsterdam, Netherlands
| | - Brian Ghoshhajra
- Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Patrick W Serruys
- Clinical Science Institute, National University of Ireland, Galway, Ireland
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4
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Andreini D, Collet C, Leipsic J, Nieman K, Bittencurt M, De Mey J, Buls N, Onuma Y, Mushtaq S, Conte E, Bartorelli AL, Stefanini G, Sonck J, Knaapen P, Ghoshhajra B, Serruys P. Pre-procedural planning of coronary revascularization by cardiac computed tomography: An expert consensus document of the Society of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr 2022; 16:558-572. [PMID: 36008263 DOI: 10.1016/j.jcct.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 06/07/2022] [Accepted: 08/05/2022] [Indexed: 10/15/2022]
Abstract
Coronary CT angiography (CCTA) demonstrated high diagnostic accuracy for detecting coronary artery disease (CAD) and a key role in the management of patients with low-to-intermediate pretest likelihood of CAD. However, the clinical information provided by this noninvasive method is still regarded insufficient in patients with diffuse and complex CAD and for planning percutaneous coronary intervention (PCI) and surgical revascularization procedures. On the other hand, technology advancements have recently shown to improve CCTA diagnostic accuracy in patients with diffuse and calcific stenoses. Moreover, stress CT myocardial perfusion imaging (CT-MPI) and fractional flow reserve derived from CCTA (CT-FFR) have been introduced in clinical practice as new tools for evaluating the functional relevance of coronary stenoses, with the possibility to overcome the main CCTA drawback, i.e. anatomical assessment only. The potential value of CCTA to plan and guide interventional procedures lies in the wide range of information it can provide: a) detailed evaluation of plaque extension, volume and composition; b) prediction of procedural success of CTO PCI using scores derived from CCTA; c) identification of coronary lesions requiring additional techniques (e.g., atherectomy and lithotripsy) to improve stent implantation success by assessing calcium score and calcific plaque distribution; d) assessment of CCTA-derived Syntax Score and Syntax Score II, which allows to select the mode of revascularization (PCI or CABG) in patients with complex and multivessel CAD. The aim of this Consensus Document is to review and discuss the available data supporting the role of CCTA, CT-FFR and stress CT-MPI in the preprocedural and possibly intraprocedural planning and guidance of myocardial revascularization interventions.
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Affiliation(s)
- Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy.
| | | | - Jonathon Leipsic
- St Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Vancouver, Canada
| | - Koen Nieman
- Stanford University School of Medicine, Departments of Medicine and Radiology, USA
| | - Marcio Bittencurt
- Division of Internal Medicine, University Hospital, University of São Paulo, São Paulo, Brazil; DASA, São Paulo, Brazil; Division of Cardiology and the Heart and Vascular Institute, University of Pittsburgh Medical Center, USA
| | - Johan De Mey
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussel, Belgium
| | - Nico Buls
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussel, Belgium
| | - Yoshinobu Onuma
- Clinical Science Institute, National University of Ireland, Galway, Ireland
| | | | - Edoardo Conte
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLVZ Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Paul Knaapen
- Vrije Universiteit Medical Center, Amsterdam, Netherlands
| | - Brian Ghoshhajra
- Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Patrick Serruys
- Clinical Science Institute, National University of Ireland, Galway, Ireland
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5
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Dowling C, Nelson AJ, Lim RY, Zhang JM, Cheng K, Smith JA, Seneviratne S, Malaiapan Y, Zaman S, Wong DTL. Quantitative flow ratio to predict long-term coronary artery bypass graft patency in patients with left main coronary artery disease. Int J Cardiovasc Imaging 2022; 38:2811-2818. [DOI: 10.1007/s10554-022-02699-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 07/20/2022] [Indexed: 11/24/2022]
Abstract
Abstract
Purpose
Fractional flow reserve (FFR) has been demonstrated in some studies to predict long-term coronary artery bypass graft (CABG) patency. Quantitative flow ratio (QFR) is an emerging technology which may predict FFR. In this study, we hypothesised that QFR would predict long-term CABG patency and that QFR would offer superior diagnostic performance to quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS).
Methods
A prospective study was performed on patients with left main coronary artery disease who were undergoing CABG. QFR, QCA and IVUS assessment was performed. Follow-up computed tomography coronary angiography and invasive coronary angiography was undertaken to assess graft patency.
Results
A total of 22 patients, comprising of 65 vessels were included in the analysis. At a median follow-up of 3.6 years post CABG (interquartile range, 2.3 to 4.8 years), 12 grafts (18.4%) were occluded. QFR was not statistically significantly higher in occluded grafts (0.81 ± 0.19 vs. 0.69 ± 0.21; P = 0.08). QFR demonstrated a discriminatory power to predict graft occlusion (area under the receiver operating characteristic curve, 0.70; 95% confidence interval [CI], 0.52 to 0.88; P = 0.03). At long-term follow-up, the risk of graft occlusion was higher in vessels with a QFR > 0.80 (58.6% vs. 17.0%; hazard ratio, 3.89; 95% CI, 1.05 to 14.42; P = 0.03 by log-rank test). QCA (minimum lumen diameter, lesion length, diameter stenosis) and IVUS (minimum lumen area, minimum lumen diameter, diameter stenosis) parameters were not predictive of long-term graft patency.
Conclusions
QFR may predict long-term graft patency in patients undergoing CABG.
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6
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Terentes-Printzios D, Oikonomou D, Gkini KP, Gardikioti V, Aznaouridis K, Dima I, Tsioufis K, Vlachopoulos C. Angiography-based estimation of coronary physiology: A frame is worth a thousand words. Trends Cardiovasc Med 2021; 32:366-374. [PMID: 34329733 DOI: 10.1016/j.tcm.2021.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 07/04/2021] [Accepted: 07/21/2021] [Indexed: 02/04/2023]
Abstract
Cumulative evidence has shown that coronary revascularization should be guided by functional significance of coronary lesions. Fractional flow reserve (FFR) is the gold standard for assessment of hemodynamic significance of coronary stenosis and FFR-guided percutaneous coronary intervention has improved clinical outcomes in patients with coronary artery disease. However, limitations of FFR such as increased operational time and cost, requirement of pressure wire and adenosine and technical difficulties have led to significant underutilization of the method in clinical practice. In the last few years, several methods of FFR estimation based on coronary angiography images have emerged to overcome invasive FFR limitations. The common elements of the novel indices include a 3D anatomical reconstruction of coronary vessels by angiographic projections and various approaches to fluid dynamics computation. Angiography-derived FFR methods have shown high diagnostic accuracy compared to invasive FFR. Although there are promising results regarding their prognostic role, large randomized trials evaluating clinical outcomes are lacking. The aim of this review is to present currently available angiography-derived FFR indices and highlight their differences, advantages, disadvantages and potential clinical implications.
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Affiliation(s)
- Dimitrios Terentes-Printzios
- First Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration Hospital, Athens, Greece.
| | - Dimitrios Oikonomou
- First Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration Hospital, Athens, Greece
| | - Konstantia-Paraskevi Gkini
- First Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration Hospital, Athens, Greece
| | - Vasiliki Gardikioti
- First Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration Hospital, Athens, Greece
| | - Konstantinos Aznaouridis
- First Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration Hospital, Athens, Greece
| | - Ioanna Dima
- First Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration Hospital, Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration Hospital, Athens, Greece
| | - Charalambos Vlachopoulos
- First Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration Hospital, Athens, Greece
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7
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G Toth G, Collet C, Langhoff Thuesen A, Mizukami T, Casselman F, Riber LP, Van Praet F, Junker A, Nagumo S, De Bruyne B, Okkels Jensen L, Barbato E. Influence of fractional flow reserve on grafts patency: Systematic review and patient-level meta-analysis. Catheter Cardiovasc Interv 2021; 99:730-735. [PMID: 34233071 PMCID: PMC9546321 DOI: 10.1002/ccd.29864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/11/2021] [Accepted: 06/25/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate the impact of invasive functional guidance for coronary artery bypass graft surgery (CABG) on graft failure. BACKGROUND Data on the impact of fractional flow reserve (FFR) in guiding CABG are still limited. METHODS Systematic review and individual patient data meta-analysis were performed. Primary objective was the risk of graft failure, stratified by FFR. Risk estimates are reported as odds ratios (ORs) derived from the aggregated data using random-effects models. Individual patient data were analyzed using mixed effect model to assess relationship between FFR and graft failure. This meta-analysis is registered in PROSPERO (CRD42020180444). RESULTS Four prospective studies comprising 503 patients referred for CABG, with 1471 coronaries, assessed by FFR were included. Graft status was available for 1039 conduits at median of 12.0 [IQR 6.6; 12.0] months. Risk of graft failure was higher in vessels with preserved FFR (OR 5.74, 95% CI 1.71-19.29). Every 0.10 FFR units decrease in the coronaries was associated with 56% risk reduction of graft failure (OR 0.44, 95% CI 0.34 to 0.59). FFR cut-off to predict graft failure was 0.79. CONCLUSION Surgical grafting of coronaries with functionally nonsignificant stenoses was associated with higher risk of graft failure.
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Affiliation(s)
- Gabor G Toth
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Anne Langhoff Thuesen
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Takuya Mizukami
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.,Clinical Research Institute for Clinical Pharmacology and Therapeutics, Showa University, Tokyo, Japan
| | - Filip Casselman
- Departement of Cardiovascular and Thoracic Surgery, OLV Hospital Aalst, Aalst, Belgium
| | - Lars Peter Riber
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Frank Van Praet
- Departement of Cardiovascular and Thoracic Surgery, OLV Hospital Aalst, Aalst, Belgium
| | - Anders Junker
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Sakura Nagumo
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.,Division of Cardiology, Department of Internal medicine, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.,Department of Cardiology, Universtiy Hospital Center Lausanne, Lausanne, Switzerland
| | | | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
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