Mj. Kern et al., CLINICAL OUTCOME OF DEFERRING ANGIOPLASTY IN PATIENTS WITH NORMAL TRANSLESIONAL PRESSURE-FLOW VELOCITY-MEASUREMENTS, Journal of the American College of Cardiology, 25(1), 1995, pp. 178-187
Objectives. The objective of this study was to determine the feasibili
ty, safety and outcome of deferring angioplasty in patients with angio
graphically intermediate lesions that are found not to limit how, as d
etermined by direct translesional hemodynamic assessment. Background.
The clinical importance of some coronary stenoses of intermediate angi
ographic severity frequently requires noninvasive stress testing. Dire
ct translesional pressure and flow measurements may assist in clinical
decision making in patients with such stenoses. Methods. Translesiona
l spectral flow velocity (Doppler guide wire) and pressure data were o
btained in 88 patients for 100 lesions (26 single-vessel and 74 multiv
essel coronary artery lesions) with quantitative angiographic coronary
narrowings (mean +/- SD diameter narrowing 54 +/- 7% [range 40% to 74
%]). Target lesion angioplasty was prospectively deferred on the basis
of predetermined normal values, defined as a proximal/distal velocity
ratio <1.7 or a pressure gradient <25 mm Hg, or both. Patients were f
ollowed up for 9 +/- 5 months (range 6 to 30). Results. In the deferre
d angioplasty group, translesional velocity ratios, were similar to th
ose of a normal reference group (mean 1.1 +/- 0.32 vs. 13 +/- 0.55) an
d significantly lower than those of a reference cohort of patients who
had undergone angioplasty (2.27 +/- 1.2, p < 0.05). The mean transles
ional pressure gradient in the deferred angioplasty group was also low
er than that in the angioplasty group (10 +/- 9 vs, 45 +/- 22 mm Hg, p
< 0.001). At follow-up in the deferred angioplasty group, four, six,
zero and two patients, respectively, had had subsequent angioplasty, c
oronary artery bypass graft surgery or myocardial infarction or had di
ed. In one patient, death was related to angioplasty of a nontarget ar
tery lesion, and one patient with multivessel disease had a cardiac ar
rest due to ventricular fibrillation 12 months after lesion assessment
. Among the 10 patients requiring later angioplasty or coronary artery
bypass grafting, only six procedures were performed on target arterie
s. No patient had a complication of translesional flow or pressure mea
surements. Conclusions. These data demonstrate the safety, feasibility
and clinical outcome of deferring angioplasty of coronary artery narr
owings associated with normal translesional coronary hemodynamic varia
bles. Given the practice of performing angioplasty without ischemic te
sting or when testing is inconclusive, translesional hemodynamic data
obtained at diagnostic catheterization can identify patients in whom i
t is safe to postpone angioplasty.