Conflicting functional assessment of stenoses in patients with previous myocardial infarction

Leesar, Massoud A.; Abdul-Baki, Talal; Yalamanchili, Vankata; Hakim, John; Kern, Morton J.

doi:10.1002/ccd.10550

Cited by 6 publications

(4 citation statements)

References 24 publications

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“…However, Meuwissen et al [13] demonstrated that variations in microvascular resistance had an impact on the hemodynamic parameters used in the evaluation of a coronary stenosis, with significant increases in microvascular resistance leading to higher FFR values despite an anatomically fixed stenosis. Also, it has been demonstrated that an infarcted myocardial bed is associated with a microvascular injury which can lead to a decreased maximal hyperaemic flow response and the subsequent underestimation of the functional severity of a coronary stenosis [14–16]. The results of the present study showed a higher event rate in patients with previous myocardial infarction in the territory evaluated by FFR measurement, suggesting that a potential overestimation of FFR measurements obtained in an infarcted territory might have contributed to the higher incidence of cardiac events in patients who had revascularization deferral on the basis of borderline FFR values.…”

Section: Discussionmentioning

confidence: 52%

Comparison of medical treatment and coronary revascularization in patients with moderate coronary lesions and borderline fractional flow reserve measurements

Courtis

Rodés‐Cabau

Larose

et al. 2008

Cathet Cardio Intervent

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In patients with moderate coronary lesions and borderline FFR measurements deferral of revascularization was associated with a higher rate of MACE (CR) and a higher prevalence of angina at follow-up, especially in those with previous MI in the territory evaluated by FFR. Further prospective randomized studies should confirm whether or not an FFR cut-off point of 0.80 instead of 0.75 would be more appropriate for deferring CR in these cases.

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Section: Discussionmentioning

confidence: 52%

Comparison of medical treatment and coronary revascularization in patients with moderate coronary lesions and borderline fractional flow reserve measurements

Courtis

Rodés‐Cabau

Larose

et al. 2008

Cathet Cardio Intervent

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“…The 5-year risk of cardiac death or myocardial infarction (MI) in patients with normal FFR is Ͻ1% per year and is not decreased by stenting. Treating patients guided by FFR is associated with a low event rate, comparable to event rates in patients with normal noninvasive testing (Table 3) (41)(42)(43)(44)(45)(46)(47)(48)(49)(50).…”

Section: Outcome Of Using Ffr For Intermediate Lesionsmentioning

confidence: 62%

Current Concepts of Integrated Coronary Physiology in the Catheterization Laboratory

Kern

Samady

2010

Journal of the American College of Cardiology

263

168

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Over the last 15 years, the use of invasive coronary physiology in the catheterization laboratory has demonstrated favorable outcomes for decision making in patients with intermediate single-vessel stenoses, complex bifurcation and ostial branch stenoses, multivessel coronary artery disease, and left main stenoses. A recent large multicenter study (FAME [FFR versus Angiography for Multivessel Evaluation]) found that a physiologically-guided approach was superior to the standard angiographically-guided approach for percutaneous revascularization in patients with multivessel coronary artery disease. This review addresses selected pertinent concepts and studies supporting the integration of coronary physiology in the catheterization laboratory for optimal patient outcomes.

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“…However, the MACE rate of these patients may range from 8 to 21% [21][22][23][24][25]. We set out this exploratory study to investigate whether plaque composition could be one of the reasons to explain this occurrence of events if these lesions are left untreated, based on FFR findings.…”

Section: Discussionmentioning

confidence: 99%

Morphology of coronary artery lesions assessed by virtual histology intravascular ultrasound tissue characterization and fractional flow reserve

Brugaletta

García‐García

Shen

et al. 2011

Int J Cardiovasc Imaging

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Fractional flow reserve (FFR) is an index of the physiological significance of a coronary stenosis. Patients who have lesions with a FFR of >0.80, even optimally treated with medication, have however a MACE rate ranging from 8 to 21%. Coronary plaques at high risk of rupture and clinical events can be also identified by virtual histology intravascular ultrasound (IVUS-VH) as plaques with high amount of necrotic core (NC) abutting the lumen. Aim of this exploratory study was to investigate whether the geometry and composition of lesions with FFR ≤ 0.80 were different from their counterparts. Fifty-five consecutive patients in whom FFR was clinically indicated on a moderate angiographic lesion, received also an imaging investigation on the same lesion with IVUS-VH. Data on plaque geometry and composition was analyzed. Patients were subdivided in two groups according to the value of FFR (> or ≤0.80). Lesions with a FFR ≤ 0.80 (n = 17) showed a slightly larger plaque burden than those with FFR > 0.80 (n = 38) (54.6 ± 0.7% vs. 51.7 ± 0.7% P = 0.1). In addition, they tend to have less content of necrotic core than their counterparts (14.2 ± 8% vs. 19.2 ± 10.2%, P = 0.08). No difference was found in the distribution of NC-rich plaques (fibroatheroma and thin-capped fibroatheroma) between groups (82% in FFR ≤ 0.80 vs. 79% in FFR > 0.80, P = 0.5). Although FFR ≤ 0.80 lesions have larger plaque size, they do not differ in composition from the ones with FFR > 0.80. Further exploration in a large prospective study is needed to study whether the lesions with FFR > 0.80 that are NC rich are the ones associated with the presence of clinical events at follow-up.

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Conflicting functional assessment of stenoses in patients with previous myocardial infarction

Cited by 6 publications

References 24 publications

Comparison of medical treatment and coronary revascularization in patients with moderate coronary lesions and borderline fractional flow reserve measurements

Comparison of medical treatment and coronary revascularization in patients with moderate coronary lesions and borderline fractional flow reserve measurements

Current Concepts of Integrated Coronary Physiology in the Catheterization Laboratory

Morphology of coronary artery lesions assessed by virtual histology intravascular ultrasound tissue characterization and fractional flow reserve

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