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December 2, 2008EchocardiographyOpen Access

Clinical Outcome in Patients with Intermediate Stenosis of Left Anterior Descending Coronary Artery after Deferral of Revascularization on the Basis of Noninvasive Coronary Flow Reserve Measurement

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Key result

Deferral of revascularization for medical treatment based on a coronary flow reserve > 2 resulted in similar survival from cardiac events compared to PTCA (86.4% vs 88.3%; P=0.36).

Why the study?

Does deferral of revascularization based on noninvasive CFR > 2 result in similar clinical outcomes compared to PTCA in patients with intermediate LAD stenosis?

Population

280 patients with intermediate left anterior descending coronary artery stenosis, mean age 62.2 +/- 9.6 years.

Comparison

Medical treatment guided by noninvasive… vs Percutaneous transluminal coronary angioplasty…

Design

Cohort

Follow-up

mean 43 +/- 11 months (range 12-52 months)

Authors

ADAntonello D’AndreaSSSergio SeverinoCMClaudia Mita

Discussion

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Overview

May support deferral of PTCA for intermediate LAD stenosis with CFR >2; leaves open need for randomized confirmation.

Study Design

Type

Cohort (n=280)

Structured PICO

Does deferral of revascularization based on noninvasive CFR > 2 result in similar clinical outcomes compared to PTCA in patients with intermediate LAD stenosis?

P
Population
280 patients (mean age 62.2 years) with intermediate LAD stenosis (50-70% by angiography) followed for a mean of 43 months.
E
Exposure
Medical treatment (deferral of revascularization) guided by noninvasive transthoracic coronary flow reserve (CFR) > 2 after dipyridamole infusion
C
Comparator
Percutaneous transluminal coronary angioplasty (PTCA) guided by noninvasive transthoracic CFR <= 2
O
Outcome
Cardiac death, myocardial infarction, coronary revascularization procedure, and unstable anginacomposite

Main Result

Absolute Event Rate: 86.4% vs 88.3%

p-value: p=0.36

Deferral of revascularization for intermediate LAD stenosis based on a noninvasive CFR > 2 yields similar long-term clinical outcomes compared to PTCA for CFR <= 2.

Limitations

  • CFR as a 'stand-alone' diagnostic criterion suffers from several structural limitations
  • CFR as a stand-alone diagnostic criterion suffers from several structural limitations

Cite This Study

D’Andrea et al. (2008) conducted a cohort in Intermediate stenosis of the left anterior descending coronary artery (n=280). Medical treatment (CFR > 2) vs. PTCA (CFR <= 2) was evaluated on Cardiac death, myocardial infarction, coronary revascularization procedure, and unstable angina (p=0.36). Deferral of revascularization for medical treatment based on a coronary flow reserve > 2 resulted in similar survival from cardiac events compared to PTCA (86.4% vs 88.3%; P=0.36).

synapsesocial.com/papers/6a881814afcf99b77fbbf8edhttps://doi.org/10.1111/j.1540-8175.2008.00807.x
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Deferring angioplasty in intermediate coronary lesions based on coronary flow criteria is safe: comparison of a deferred group to an intervention group1999 · 10 citations
  2. 2The prognostic significance of coronary flow reserve in the risk stratification of patients with chronic total occlusion of the right coronary artery and the intermediary stenosis of the left coronary artery2020
  3. 3Noninvasive Assessment of Coronary Flow Reserve in the Left Anterior Descending Artery by Transthoracic Echocardiography before and after Stenting2007 · 8 citations
  4. 4Long‐Term Prognostic Significance of Coronary Flow Velocity Reserve in Patients with Significant Coronary Artery Disease Not Involving the Left Anterior Descending Coronary Artery (Results from the SZEGED Study)2010 · 9 citations
  5. 5Non-invasive coronary flow reserve after successful primary angioplasty for acute anterior myocardial infarction is an independent predictor of left ventricular adverse remodelling2010 · 17 citations