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Published on: November 24, 2014
An objective method for grading of distal disease in the grafted coronary arteries
1Division of Cardiothoracic Surgery, King Khalid University Hospital, Riyadh, Saudi Arabia. anjumjalal1@hotmail.com
Insights
A new grading system objectively assesses coronary artery disease diffuseness, improving coronary bypass grafting outcomes. This method correlates with graft flow, offering reliable severity assessment.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Biomedical Engineering
Background:
- Assessing coronary artery disease (CAD) diffuseness is crucial for predicting coronary bypass grafting (CABG) outcomes.
- Current methods lack objectivity, hindering accurate prognostication and surgical planning.
- An objective grading system for CAD diffuseness is needed to improve patient management.
Purpose of the Study:
- To propose and validate an objective grading system for the diffuseness of distal coronary artery disease.
- To correlate this grading system with objective hemodynamic measurements using transit time flow measurements.
- To establish a reliable tool for assessing the severity of disease in grafted coronary arteries.
Main Methods:
- Developed a grading system (0-3) based on distal vessel size and atheromatous lesion characteristics.
- Analyzed 186 patients undergoing isolated coronary bypass grafting between July 2004 and August 2006.
- Validated the grading system using transit time flow measurements, assessing graft flow and pulsatility index.
Main Results:
- The proposed grading system demonstrated a moderate positive correlation with pulsatility index (P<0.0001).
- A moderate negative correlation was observed between graft flow and the grade of diffuseness (P<0.0001).
- The system proved to be an objective and reliable method for assessing distal disease severity.
Conclusions:
- The developed grading system provides an objective and reliable assessment of distal coronary artery disease severity.
- This tool can aid in surgical decision-making and improve the prediction of coronary bypass grafting outcomes.
- Further research can explore the integration of this grading system into routine clinical practice.
Abstract:
The impact of diffuseness of coronary artery disease on the outcome of coronary bypass grafting remains unclear due to the absence of an objective grading system for diffuseness. This study proposes a system and validates it by transit time flow measurements. All patients operated upon by the author from July 2004 to August 2006 were enrolled in the study. The patients who had procedures other than isolated coronary bypass grafting were excluded. This resulted in a set of 186 (151 male and 35 female) patients with a mean age of 59.55 years. Those vessels which had endarterectomies, on-lay patches, multiple/sequential grafts to a single artery were removed from analysis. The diffuseness of distal disease was graded from 0 to 3 on the basis of (i) the size of vessel and (ii) the number as well as significance of atheromatous lesions distal to the graft. The correlation analysis showed a moderate positive correlation between pulsitility index and grade of diffuseness and a moderate negative correlation between graft flow and grade of diffuseness (P<0.0001). This study shows that the proposed method of grading provides an objective and reliable system for the assessment of severity of distal disease in the grafted coronary arteries.
