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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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Premsagar P, Aldous C, Esterhuizen T. Cardiac scoring systems, coronary artery disease and major adverse cardiovascular events: A scoping review. S Afr Fam Pract (2004) 2023; 65:e1-e8. [PMID: 37782230 PMCID: PMC10476223 DOI: 10.4102/safp.v65i1.5683] [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: 11/22/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND In 2019, the World Health Organization (WHO) declared coronary artery disease (CAD) as the leading cause of death globally for the last 20 years. Early screening and detection (primary prevention) and intervention (secondary prevention) are necessary to curb CAD and major adverse cardiovascular event (MACE) prevalence. A scoping review to assess the current literature on using cardiac scoring systems to predict CAD and MACE was performed. METHODS The research question 'What is the literature on using cardiac scoring systems to predict CAD and MACE?' was addressed. The updated Arksey and O'Malley and the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews methodologies were used. The search terms 'coronary artery disease' and 'cardiac scoring systems' and 'major adverse cardiovascular events' were used in the Boolean search on PubMed, ScienceDirect, MedLine and Cochrane Library. RESULTS The final list consisted of 19 published English results after the year 2000. There were six results without participants (four clinical guidelines, one review article and one ongoing clinical trial). Scoring systems were cardiovascular risk estimation systems focusing on the primary prevention of CAD; MACE was discussed but not scored. There were 13 robust results published from completed multinational clinical trials with participants. These results focused on a scoring system for the secondary prevention of CAD and MACE. CONCLUSION Scoring systems remain an objective method for primary and secondary prevention of CAD and MACE.Contribution: Scoring systems may be helpful with clinical uncertainty or to standardise patient results for comparison in research.
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Affiliation(s)
- Preesha Premsagar
- Department of Internal Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban.
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