ACC/AHA Guidelines for Coronary Angiography: Executive Summary and Recommendations

Kim

et al. 2013

Nucl Med Mol Imaging

Purpose The purpose of this study is to compare the myocardial blood flow (MBF) and flow reserve (MFR) between proximal and mid-to-distal lesions of the left anterior descending artery (pLAD and mdLAD, respectively) using N-13 ammonia positron emission tomography/computed tomography (PET/CT). Methods Subjects were 11 patients (six men and five women, mean age 64.5 years) with known coronary artery disease (CAD) involving LAD studied by N-13 ammonia PET/CT. They were divided into two groups by the location of stenotic lesions, i.e. pLAD versus mdLAD. Global and regional MBF and MFR were measured and compared. Characteristics of perfusion defects including the number of involved segments, basal area involvement, location, size, and shape were also compared between the two groups. Results The regional MFR in mid-anterior segment was significantly lower in pLAD group (1.80±0.35 vs 2.76±1.13 for pLAD and mdLAD groups, respectively, p=0.034), while global MFR was not different (2.10±1.10 vs 2.34±0.84).Both stress and rest MBF in LAD territories were not different in both groups. The size of the perfusion defects were significantly larger in pLAD group (44.0±11.5 % vs 21.1±15.8 %, p=0.041). Other characteristics such as location, basal area involvement, and shape were not significantly different between two groups. Conclusions The proximal lesion makes lower MFR in the mid-anterior segment and larger perfusion defect in the LAD territory but comparable MBF compared with mdLAD lesion.

Section: Patientssupporting

confidence: 74%

Myocardial Blood Flow and Flow Reserve in Proximal and Mid-to-Distal Lesions of Left Anterior Descending Artery Measured By N-13 Ammonia PET/CT

Kim

et al. 2013

Nucl Med Mol Imaging

“…4 Interventional cardiologists coded the location and severity of diseased and treated arterial segments according to the specifications contained in Appendix A of those guidelines. Cardiologists typically used visual estimates to assess reference vessel diameter, lesion length, and diameter stenoses, and these measurements were recorded in the interventional procedure record.…”

Section: Methodsmentioning

confidence: 99%

Bare-metal stent outcomes in an unselected patient population

Yock

Isbill²,

King

2006

Clin Cardiol

SummaryBackground: Randomized trials have shown that drug-eluting stents (DES) substantially reduce in-stent restenosis compared with bare-metal stents (BMS).Hypothesis: Revascularization event rates related to BMS restenosis may be higher in the trials setting than in real-world experience, calling into question the extent of benefit possible with widespread DES use in regular practice.Methods: Between December 1998 and March 2003, 17,102 patients with BMS registered in the Goodroe Healthcare Solutions Data Warehouse met the inclusion criteria for this retrospective study of catheterization laboratory data. We examined the database for evidence of diagnostic angiography or percutaneous coronary intervention (PCI) readmission within 1 year after stenting.Results: Repeat PCI was documented for 2,070 patients, and 232 were referred for coronary artery bypass graft surgery (CABG)-in sum, 13.5% of the cohort. Stented region revascularization was observed in 8.4%: 1,350 patients underwent subsequent PCI, and 84 of the patients referred for CABG had in-stent lesion recurrence. Only 1,207 (7.1%) patients required stent-related PCI after 30 days, the time frame consistent with restenosis.Conclusions: In this "real-world" series, reintervention of a stented region after the first follow-up month was documented in fewer than 8% of patients in a large cohort that had received BMS. The rate of clinical events potentially related to BMS instent restenosis in this large, unselected patient population is substantially lower than that in the control arms of some DES trials. The incremental benefit of widespread conversion from

Int J Cardiovasc Imaging

“…X-ray coronary angiography provides a definitive evaluation of luminal coronary obstruction but is currently only an American Heart Association (AHA) Class IIB indication for systolic dysfunction without angina and is associated with a 1.7% risk of major complication [12]. To avoid the risks and complications of an invasive evaluation, a noninvasive strategy would be an attractive alternative.…”

Section: Introductionmentioning

confidence: 99%

Can late gadolinium enhancement by cardiovascular magnetic resonance identify coronary artery disease as the etiology of new onset congestive heart failure?

Schietinger

Vörös

Isbell

et al. 2007

Background-New left ventricular systolic dysfunction affects 500,000 Americans and coronary artery disease (CAD) is responsible for two-thirds of cases. Identifying CAD has both prognostic and therapeutic implications. We evaluated the ability of late gadolinium enhancement (LGE) by cardiovascular magnetic resonance imaging (CMR) to detect CAD as the etiology of recent onset congestive heart failure (CHF).