Coronary pressure measurement identifies patients with diffuse coronary artery disease who benefit from coronary revascularization

Abstract

We analyzed the pressure drop pattern in patients with diffuse coronary artery disease and treated these patients according to their pressure drop pattern. We measured pullback coronary pressure from the distal to the proximal left anterior descending coronary artery in 83 patients with diffuse coronary artery disease. Coronary pressure pattern was divided into two types: the abrupt and gradual pressure drop patterns. Patients with an abrupt pressure drop pattern and fractional flow reserve less than 0.75 underwent coronary revascularization. Patients with gradual pressure drop pattern received medical therapy except five patients, who underwent coronary bypass surgery because of triple vessel disease. We followed these patients for 8-20 (14.3±4.6) months using the grading system of the Canadian Cardiovascular Society (CCS grade). Abrupt pressure drop pattern was observed in 47 patients, whereas the remaining 36 patients showed gradual pressure drop pattern. Angiographic findings did not distinguish these pressure drop patterns. All patients with the abrupt pressure drop pattern except one showed symptomatic improvement (the CCS grade decreased from 2.64±0.76 to 1.09±0.35, P<0.01) in response to coronary revascularization. In patients with the gradual pressure drop pattern, 17 of 36 patients showed improvement of symptoms (the CCS grade decreased from 2.31±0.53 to 1.75±0.77, P<0.01). Coronary pressure measurement distinguished patients with abrupt pressure drop pattern from those with gradual pressure drop pattern, and the former group of patients benefited from coronary revascularization.