[Myocardial revascularization : Controversy over noninvasive and invasive detection of ischemia]
Luise Gaede1, Johannes Blumenstein2,3, Helge Möllmann4
1Medizinische Klinik 2, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland.
Insights
For chronic coronary syndrome (CCS), revascularization is beneficial if myocardial ischemia exceeds 10%. Measuring hemodynamic significance during angiography aids decisions, especially with unclear ischemia, improving patient outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Myocardial revascularization decisions for chronic coronary syndrome (CCS) typically rely on the extent of myocardial ischemia.
- Current guidelines suggest benefit when ischemia affects over 10% of the myocardium.
Purpose of the Study:
- To evaluate the role of noninvasive ischemia testing before diagnostic coronary angiography in CCS patients.
- To assess the benefit of measuring hemodynamic significance of coronary stenoses during angiography for revascularization decisions, particularly in cases with equivocal ischemia.
Main Methods:
- Noninvasive ischemia testing for all CCS patients prior to diagnostic coronary angiography.
- Measurement of hemodynamic significance of coronary stenoses (lumen diameter reduction ≥ 50%) during coronary angiography.
Main Results:
- Noninvasive ischemia testing can identify patients likely to benefit from revascularization (ischemia > 10%).
- Measuring hemodynamic significance during angiography provides data for revascularization decisions, even with initially unclear ischemia.
- Revascularization decisions based on hemodynamic significance have demonstrated patient benefit in multiple studies.
Conclusions:
- Noninvasive ischemia testing is crucial for guiding revascularization in CCS.
- Hemodynamic assessment during coronary angiography is valuable for optimizing revascularization strategies in select CCS patients.
- Evidence supports using hemodynamic significance to guide revascularization, improving patient outcomes.
Abstract:
With some exceptions, myocardial revascularization in patients with chronic coronary syndrome (CCS) is generally decided on the basis of the extent of myocardial ischemia. Current data indicate that a patient will benefit from revascularization if ischemia is present in more than 10% of the myocardium. Accordingly, all patients presenting with CCS should undergo a noninvasive ischemia test that can answer this question before diagnostic coronary angiography. In order to be able to make a recommendation for revascularization based on scientific data even in those patients who previously had no clear evidence of ischemia, e.g., because of discrepant findings, measurement of the hemodynamic significance of coronary stenoses with a lumen diameter reduction ≥ 50% should be performed during coronary angiography. A decision to revascularize based on hemodynamic significance was shown to be beneficial to patients in several studies.
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