Single Coronary Artery Lesions Research Articles

TCTAP A-147 Five-Year Clinical Outcomes of Patients with Large Vessel and Single Coronary Artery Lesion: Comparison of Bare-Metal Stent, 1st Generation and 2nd Generation Drug-Eluting Stent

TCTAP A-147 Five-Year Clinical Outcomes of Patients with Large Vessel and Single Coronary Artery Lesion: Comparison of Bare-Metal Stent, 1st Generation and 2nd Generation Drug-Eluting Stent

Diagnostic accuracy of quantitative angiographic and intravascular ultrasound parameters predicting the functional significance of single de novo lesions

The current study aimed at determining the best cutoff value of angiographic and intravascular ultrasound (IVUS) parameters for defining fractional flow reserve (FFR) <0.8 in patients with single coronary artery lesion. The correlation between angiographic or IVUS variables and FFR in patients with single coronary artery lesions has not been studied yet. Quantitative coronary analysis and IVUS and FFR measurements were used in 323 patients with a single lesion. The best angiographic and IVUS cutoff values and their predictive value for FFR<0.8 were compared using area under the receiver-operator characteristic curve (AUC). FFR<0.8 was in 54.2%. Minimal lumen area (MLA), plaque burden (PB), lesion length (LL) and lesion at left anterior descending artery (LAD) were four predictors of FFR<0.8. LL had less value in predicting FFR<0.8. The cutoff values of PB and MLA for FFR<0.8 were 72.7% and 2.97 mm(2). MLA and PB had similar high diagnostic value for vessel size ≥ 3 mm (cutoff values: 3.02 mm(2) and 80.7%), proximal LAD lesion (cutoff values: 3.04 mm(2) and 76.5%) and unstable angina (2.82 mm(2) and 71.9%). Combination of MLA (2.82 mm(2)) and PB (80.6%) had increased diagnostic value for distal LAD lesion. Only PB (71%) had higher diagnostic value for diabetic patients. MLA and PB could not predict FFR<0.8 for vessel size<3mm, and non-LAD lesion. Best cutoff value of MLA and PB for FFR<0.8 in patients with a single lesion is patient-, vessel size- and lesion location-oriented. PB has strengthened diagnostic accuracy for diabetic patients.

Clinical and Angiographic Outcomes of Drug‐Eluting Stents in Patients With Large Vessel and Single Coronary Artery Lesion

The aim of this study was to evaluate and compare the clinical and angiographic outcomes of 3 drug-eluting stents (DES) in patients with large vessel diameter and single coronary artery lesions. The efficacy of 3 DESs may be similar. A total of 411 consecutive patients who visited 3 university hospitals from June 2004 to December 2007 and had a single coronary lesion which was treated with the use of a DES that was 3.5 mm in diameter were enrolled in this study. Patients were divided into 3 stent groups: Paclitaxel-eluting stent (PES, n = 105), Sirolimus-eluting stent (SES, n = 259), and Zotarolimus-eluting stent (ZES, n = 47). The study end point was a composite of major adverse cardiac events (MACE) including cardiac death, myocardial infarction (MI), and ischemia-driven target-vessel revascularization (TVR) for 12 months. Baseline characteristics were not different. Late loss was higher in the ZES group than the other stents (0.5 +/- 0.4 mm in SES vs 0.3 +/- 0.5 mm in PES, 0.7 +/- 0.5 mm in ZES, P = 0.001). The total MACE-free survival rate was not significantly different between the SES group and the PES group (98.8% in SES vs 97.1% in PES, P = 0.252) or the PES group and the ZES group (97.1% in PES vs 93.6% in ZES, P = 0.301). However, the SES group showed a significantly better MACE-free survival rate compared with the ZES group (98.8% in SES vs 93.6% in ZES, P = 0.018). Clinical and angiographic outcomes of DES in a large vessel diameter and single coronary artery is excellent and SES appears to show better angiographic and clinical outcomes than ZES.

Evaluation of Subendocardial and Subepicardial Left Ventricular Functions Using Tissue Doppler Imaging after Complete Revascularization

We aim to evaluate subepicardial and subendocardial left ventricular (LV) functions in patient single coronary artery lesion at early stage after percutaneous coronary intervention (PCI). Additionally, a comparison of LV functions between patients and control cases was aimed. Patients with culprit left anterior descending (LAD) lesion (n = 25) and subjects with normal coronary angiography (n = 25) were evaluated. Patients underwent PCI and at least one coronary stent was placed. After PCI, the pulsed-wave tissue Doppler imaging (pw-TDI) parameters taken from subepicardial and subepicardial layers were compared among the patients. Left atrium (P = 0.050), LV end-diastolic (P = 0.049), and end-systolic (P = 0.006) diameters were larger compared to the control group. LV inflow velocities were not different between the patient and the control group. But, the myocardial performance index was different (P = 0.049). The systolic and diastolic pw-TDI parameters were apparently different between the patient and the control group. While the systolic pw-TDI parameters did not change, the diastolic pw-TDI parameters taken from both subepicardial (circumferential contraction) and subendocardial layers (longitudinal contraction) improved after PCI. After PCI, it was shown that while Ea velocity (P = 0.012) taken from the subendocardial layer increased, IVRa velocity (P < 0.001) taken from the subepicardial layer decreased. In our study, it could be said that LV, left atrium, and aortic valve diameter increase in patients with coronary artery disease. The systolic and diastolic functions were impaired at subendocardial and subepicardial layers. These dysfunctions can be easily presented with pw-TDI. Although systolic dysfunction persists, diastolic dysfunction improves at early stage after PCI.

Minimally invasive direct coronary artery bypass: Anesthetic, monitoring, and pain control considerations

Objective: Minimally invasive direct coronary artery bypass (MIDCAB) provides many anesthetic challenges including monitoring, managing myocardial ischemia, and pain control. The objective was to evaluate the monitoring requirements and the potential benefits of preischemic conditioning and intrathecal morphine sulfate in MIDCAB patients. Design and Setting: This review was retrospective and unrandomized and was conducted at Allegheny University Hospitals, Allegheny General, Pittsburgh, PA. Participants: Sixty-four patients with single coronary artery lesions (>70% obstruction) underwent attempted MIDCAB during a 1-year period between November 1995 and November 1996. Seven patients required conversion to conventional coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) and two patients required extended thoracotomy incisions. This report describes the remaining 55 patients who underwent MIDCAB. Interventions: Some of the MIDCAB patients received intrathecal morphine before anesthetic induction. Ischemic preconditioning was assessed in a subset of patients. Results: MIDCAB was performed in 55 of 64 patients. Transesophageal echocardiography (TEE) was used in all patients and a pulmonary artery catheter was used in 43% of patients. Esmolol was used in 25% of patients to reduce motion of the left ventricle (LV) during the left internal mammary artery (LIMA)-LAD anastomosis, but was used less often as the surgeons adapted to the use of a retractor that stabilized the ventricular wall adjacent to the site of the LIMA-LAD anastomosis. LAD occlusion caused reversible, regional systolic dysfunction by TEE in the anterior and apical LV segments. During LAD occlusion, nitroglycerin was used in 61% of patients and phenylephrine in 24%. Ischemic preconditioning did not prevent increases in systemic or pulmonary artery pressures during LAD occlusion. Most (85%) patients were extubated in the operating room. Intrathecal morphine decreased postoperative analgesic requirements. The mean hospital length of stay (LOS) was 4.0 ± 1.7 days (range, 1 to 10 days). Conclusions: MIDCAB may reduce hospital LOS for patients with single vessel coronary artery lesions when compared with median sternotomy with a LIMA-LAD graft performed on cardiopulmonary bypass. Pharmacologic heart rate control during the LIMA-LAD anastomosis is not critical with the use of a surgical retractor which diminishes ventricular motion. A single 5-minute test LAD occlusion did not protect against subsequent regional Ischemic dysfunction in our subset of patients with normal baseline function.

Coronary artery revascularisation without extracorporeal circulation. Indications and results.

Coronary artery revascularisation without extracorporeal circulation is a technique which can be performed in selected patients in need of a coronary artery bypass graft. Consecutive patients (210) underwent coronary artery bypass graft without extracorporeal circulation. Indications were high risk patients, or single coronary artery lesion. To predict perioperative mortality, preoperative risk factors were reviewed, and Parsonnet score was calculated. There were seven deaths (3.3%), and univariate analysis revealed greater age, NYHA, and poor ejection fraction to be the only predictors of early mortality. Perioperative myocardial infarction included 15 patients (7.1%), most of them seen in the multiple bypass group (10/39, 26%). Patients were divided into low risk (Parsonnet score < 15) 155 patients with two deaths (1.2%), and high risk (Parsonnet score > 15) 55 patients with five deaths (9%). Complete revascularisation was performed in the low risk group, while in the high risk only the symptomatic vessel was bypassed and other angiographic lesions treated with postoperative angioplasty (10 patients). A total of 12 patients developed early postoperative angina (5.7%), 9 presented an anastomosis dysfunction which was treated by angioplasty (5) and surgery (4), and 188 patients (85.7%) did not receive transfusions while 190 patients (90.4%) did not need postoperative inotropes. Length of stay, operating room time, and medical costs were all significantly reduced. Myocardial revascularisation without extracorporeal circulation can be performed with a low operative mortality, and minimal morbidity only in patients undergoing single bypass revascularisation. It can also be performed as part of a multiple revascularisation strategy in association with angioplasty in high risks patients.

Atherosclerosis in Cebus albifrons monkeys : III. Clinical and Pathologic Studies

“Young and adult Cebus albifrons monkeys were fed either a control or an atherogenic diet for periods of up to 2 years. Some of the monkeys were necropsied at the end of 1 year. Coronary artery atherosclerosis was evaluated by determining the percentage of diseased arteries and the percentage apparent luminal stenosis in five-step cryostat sections from each of three blocks of ventricular myocardium. Arbitrary scores from 0 to 4 were made on gross stained carotid and renal arteries. Sudan IV and hematoxylin-stained cryostat sections were prepared from portions of basilar, middle cerebral, and posterior cerebral arteries. At 1 year serum cholesterol and age but not sex were related to the extent and prevalence of coronary artery disease. Atherosclerosis was slight in young test monkeys but relatively severe in adult test monkeys. Observations on the adult monkeys after 2 years were not much different from those made at 1 year. Young test female monkeys had five times as many coronary artery lesions as young test males after the 2-year period which was not true at 1 year. Single coronary artery lesions were found in one control adult male and one young control female. Carotid artery atherosclerosis was more prevalent among males than females. One adult control male had a small carotid artery lesion. One adult male test monkey had cutaneous and tendinous xanthomas. No lesion was found in the cerebral arteries of any animal. Sections of the tongue, uterus, kidney, and liver of the second-year test animals were examined for arterial lesions. Lesions, very similar to those of the small coronary arteries, were found in the intramuscular arteries of the tongues. Intrarenal arterial lesions were present in some of the cholesterol-fed monkeys of both age and sex groups. The group with the most pronounced coronary artery atherosclesosis, the adult test group, had the greatest frequency and magnitude of S-T segment deviation in the terminal electrocardiogram. One monkey of this group had discordant T waves in all leads.