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Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Physiologic assessment of moderate coronary lesions: a step towards complete revascularization in coronary artery
John C Moscona1, Jason D Stencel2, Gregory Milligan2
1Tulane Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA, USA.
Insights
Physiologic assessment using fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR) effectively guides coronary artery bypass grafting (CABG). This approach led to more complete revascularization, particularly in the circumflex system, compared to angiography alone.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Accurate diagnosis of coronary artery disease is vital for patients undergoing coronary artery bypass grafting (CABG).
- The role of physiologic assessment with fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) in guiding complete revascularization prior to CABG requires further study.
- This study compares anatomic versus physiologic assessment of moderate coronary lesions in patients referred for CABG.
Purpose of the Study:
- To compare the effectiveness of FFR/iFR-guided revascularization versus angiography-guided revascularization in patients undergoing CABG.
- To evaluate procedural and clinical outcomes over an 18-month follow-up period.
- To determine if physiologic assessment improves complete revascularization rates and graft distribution.
Main Methods:
- Retrospective review of 109 medical records of patients who underwent CABG.
- Patients were divided into two groups: FFR/iFR-guided and angiography-guided.
- Comparison of clinical characteristics, procedural outcomes, and 18-month clinical outcomes between the groups.
Main Results:
- The FFR/iFR group showed significantly higher rates of three-vessel anastomoses and venous grafting.
- Grafting to the left anterior descending artery (LAD) distribution was lower in the FFR/iFR group, while grafting to the left circumflex (LCx) artery distribution was higher.
- A trend towards reduced major adverse cardiac events (MACEs) and angina was observed in the FFR/iFR group.
Conclusions:
- Physiologic assessment (FFR/iFR) effectively guides complete revascularization in CABG patients.
- FFR/iFR-guided CABG is associated with increased three-vessel anastomoses and venous grafting.
- This approach also demonstrated improved graft distribution to the circumflex system.
Background:
An accurate diagnostic assessment of coronary artery disease is crucial for patients undergoing coronary artery bypass grafting (CABG). Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) to guide complete revascularization have not been adequately studied in patients prior to CABG. We compared an anatomic to a physiologic assessment of moderate coronary lesions (40-70% stenosis) in patients referred for CABG.
Methods:
We retrospectively reviewed 109 medical records of patients who underwent CABG at Tulane Medical Center from 2014 to 2016. Patients were divided into an FFR/iFR-guided and an angiography-guided group. Clinical characteristics, procedural outcomes, and clinical outcomes for the two groups were compared over an 18-month follow-up period.
Results:
There were significantly higher rates of three-vessel anastomoses (85.7% vs. 74.7%, P<0.05) and venous grafting (85.7% vs. 76.8%, P<0.05) in the FFR/iFR group. The FFR/iFR group had a lower rate of grafts placed to the left anterior descending artery (LAD) distribution than the angiography group (7.1% vs. 29.5%, P<0.05). The FFR/iFR group had a higher rate of grafts placed to the left circumflex (LCx) artery distribution than the angiography group (28.6% vs. 9.5%, P<0.05). We observed a trend toward reduction in major adverse cardiac events (MACEs) (7.1% vs. 11.6%, P=0.369) and angina (0.0% vs. 6.3%, P=0.429) in the FFR/iFR group compared to the angiography group over 18 months.
Conclusions:
Physiologic assessment of coronary lesions can effectively guide complete revascularization in patients undergoing CABG. Moreover, FFR/iFR-guided CABG was associated with significantly higher rates of three-vessel anastomoses, venous grafting, and graft distribution to the circumflex system.
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