The Korean Journal of Medicine

  • 제87권6호
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  • Pages.675-685
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  • 2014
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  • 1738-9364(pISSN)
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  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
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안정형 협심증 환자에서 허혈에 기반한 치료법

Ischemia-guided Revascularization for Stable Ischemic Heart Disease

  • 김영학 (울산대학교 의과대학 서울아산병원 심장내과)
  • Kim, Young-Hak (Division of Cardiology, Department of Internal Medicine, Seoul Asan Medical Center, University of Ulsan College of Medicine)
  • 발행 : 2014.12.01
⟨ 이전 논문 다음 논문 ⟩

초록

Current evidence and guidelines support the strategy of ischemia-guided revascularization for treatment of patients with stable coronary symptoms. However, anatomical stenosis is often targeted in revascularization treatment using percutaneous coronary intervention or coronary artery bypass surgery without seriously considering objective evidence of myocardial ischemia. Angiographic complete revascularization was traditionally considered to be an ideal objective of revascularization treatment, particularly for patients with multivessel disease. However, recent observational studies have contradicted the concept of angiographic complete revascularization and have, instead, supported the benefits of ischemia-guided selective revascularization based on noninvasive and invasive functional evaluation for detection of ischemia-producing coronary lesions. No trials have been specifically designed to assess the relative benefits of either strategy. Therefore, the present review explores current concepts of the strengths and weaknesses of anatomical versus functional revascularization.

키워드

참고문헌

  1. Deyell MW, Buller CE, Miller LH, et al. Impact of national clinical guideline recommendations for revascularization of persistently occluded Infarct-related arteries on clinical practice in the United States. Arch Intern Med 2011;171:1636-1643. https://doi.org/10.1001/archinternmed.2011.315
  2. Lin GA, Dudley RA, Lucas FL, Malenka DJ, Vittinghoff E, Redberg RF. Frequency of stress testing to document ischemia prior to elective percutaneous coronary intervention. JAMA 2008;300:1765-1773. https://doi.org/10.1001/jama.300.15.1765
  3. van den Brand MJ, Rensing BJ, Morel MA, et al. The effect of completeness of revascularization on event-free survival at one year in the ARTs trial. J Am Coll Cardiol 2002;39:559-564. https://doi.org/10.1016/S0735-1097(01)01785-5
  4. Serruys PW, Morice MC, Kappetein AP, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 2009;360:961-972. https://doi.org/10.1056/NEJMoa0804626
  5. Hannan EL, Wu C, Walford G, et al. Incomplete revascularization in the era of drug-eluting stents: impact on adverse outcomes. JACC Cardiovasc Interv 2009;2:17-25. https://doi.org/10.1016/j.jcin.2008.08.021
  6. Vander Salm TJ, Kip KE, Jones RH, et al. What constitutes optimal surgical revascularization? Answers from the bypass angioplasty revascularization investigation (BARI). J Am Coll Cardiol 2002;39:565-572. https://doi.org/10.1016/S0735-1097(01)01806-X
  7. Kang SJ, Mintz GS, Park DW, et al. Mechanisms of in-stent restenosis after drug-eluting stent implantation: intravascular ultrasound analysis. Circ Cardiovasc Interv 2011;4:9-14. https://doi.org/10.1161/CIRCINTERVENTIONS.110.940320
  8. Hannan EL, Racz M, Holmes DR, et al. Impact of completeness of percutaneous coronary intervention revascularization on long-term outcomes in the stent era. Circulation 2006;113:2406-2412. https://doi.org/10.1161/CIRCULATIONAHA.106.612267
  9. Sarno G, Garg S, Onuma Y, et al. Impact of completeness of revascularization on the five-Year outcome in percutaneous coronary intervention and coronary artery bypass graft patients (from the ARTS-II study). Am J Cardiol 2010;106:1369-1375. https://doi.org/10.1016/j.amjcard.2010.06.069
  10. Rastan AJ, Walther T, Falk V, et al. Does reasonable incomplete surgical revascularization affect early or long-term survival in patients with multivessel coronary artery disease receiving left internal mammary artery bypass to left anterior descending artery? Circulation 2009;120(11 Suppl):S70-77. https://doi.org/10.1161/CIRCULATIONAHA.108.842005
  11. Synnergren MJ, Ekroth R, Odén A, Rexius H, Wiklund L. Incomplete revascularization reduces survival benefit of coronary artery bypass grafting: role of off-pump surgery. J Thorac Cardiovasc Surg 2008;136:29-36. https://doi.org/10.1016/j.jtcvs.2007.07.059
  12. Aziz A, Lee AM, Pasque MK, et al. Evaluation of revascularization subtypes in octogenarians undergoing coronary artery bypass grafting. Circulation 2009;120(11 Suppl):S65-69. https://doi.org/10.1161/CIRCULATIONAHA.108.844316
  13. Dauerman HL. Reasonable incomplete revascularization. Circulation 2011;123:2337-2340. https://doi.org/10.1161/CIRCULATIONAHA.111.033126
  14. Yoon HJ, Hur SH. Optimization of stent deployment by intravascular ultrasound. Korean J Intern Med 2012;27:30-38. https://doi.org/10.3904/kjim.2012.27.1.30
  15. Tamburino C, Angiolillo DJ, Capranzano P, et al. Complete versus incomplete revascularization in patients with multivessel disease undergoing percutaneous coronary intervention with drug-eluting stents. Catheter Cardiovasc Interv 2008;72:448-456. https://doi.org/10.1002/ccd.21666
  16. Head SJ, Mack MJ, Holmes DR Jr, et al. Incidence, predictors and outcomes of incomplete revascularization after percutaneous coronary intervention and coronary artery bypass grafting: a subgroup analysis of 3-year SYNTAX data. Eur J Cardiothorac Surg 2012;41:535-541. https://doi.org/10.1093/ejcts/ezr105
  17. Song YB, Lee SY, Hahn JY, et al. Complete versus incomplete revascularization for treatment of multivessel coronary artery disease in the drug-eluting stent era. Heart Vessels 2012;27:433-442. https://doi.org/10.1007/s00380-011-0173-x
  18. Chung JW, Park KH, Lee MH, et al. Benefit of complete revascularization in patients with multivessel coronary disease in the drug-eluting stent era. Circ J 2012;76:1624-1630. https://doi.org/10.1253/circj.CJ-11-1285
  19. Wu C, Dyer AM, King SB 3rd, et al. Impact of incomplete revascularization on long-term mortality after coronary stenting. Circ Cardiovasc Interv 2011;4:413-421. https://doi.org/10.1161/CIRCINTERVENTIONS.111.963058
  20. Généreux P, Palmerini T, Caixeta A, et al. Quantification and impact of untreated coronary artery disease after percutaneous coronary intervention: the residual SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score. J Am Coll Cardiol 2012;59:2165-2174. https://doi.org/10.1016/j.jacc.2012.03.010
  21. Rosner GF, Kirtane AJ, Genereux P, et al. Impact of the presence and extent of incomplete angiographic revascularization after percutaneous coronary intervention in acute coronary syndromes: the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial. Circulation 2012;125:2613-2620. https://doi.org/10.1161/CIRCULATIONAHA.111.069237
  22. Shaw LJ, Berman DS, Maron DJ, et al. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation 2008;117:1283-1291. https://doi.org/10.1161/CIRCULATIONAHA.107.743963
  23. Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS. Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation 2003;107:2900-2907. https://doi.org/10.1161/01.CIR.0000072790.23090.41
  24. Task force on myocardial revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS); European Association for Percutaneous Cardiovascular Interventions (EAPCI), Wijns W, et al. Guidelines on myocardial revascularization. Eur Heart J 2010;31:2501-2555. https://doi.org/10.1093/eurheartj/ehq277
  25. Lima RS, Watson DD, Goode AR, et al. Incremental value of combined perfusion and function over perfusion alone by gated SPECT myocardial perfusion imaging for detection of severe three-vessel coronary artery disease. J Am Coll Cardiol 2003;42:64-70. https://doi.org/10.1016/S0735-1097(03)00562-X
  26. Melikian N, De Bondt P, Tonino P, et al. Fractional flow reserve and myocardial perfusion imaging in patients with angiographic multivessel coronary artery disease. JACC Cardiovasc Interv 2010;3:307-314. https://doi.org/10.1016/j.jcin.2009.12.010
  27. Tonino PA, Fearon WF, De Bruyne B, et al. Angiographic versus functional severity of coronary artery stenoses in the FAME study fractional flow reserve versus angiography in multivessel evaluation. J Am Coll Cardiol 2010;55:2816-2821. https://doi.org/10.1016/j.jacc.2009.11.096
  28. Qaseem A, Fihn SD, Williams S, et al. Diagnosis of stable ischemic heart disease: summary of a clinical practice guideline from the American College of Physicians/American College of Cardiology Foundation/American Heart Association/American Association for Thoracic Surgery/Preventive Cardiovascular Nurses Association/Society of Thoracic Surgeons. Ann Intern Med 2012;157:729-734. https://doi.org/10.7326/0003-4819-157-10-201211200-00010
  29. Patel MR. Appropriate use criteria to reduce underuse and overuse: striking the right balance. J Am Coll Cardiol 2012;60:1885-1887. https://doi.org/10.1016/j.jacc.2012.07.044
  30. Gibbons RJ. Noninvasive diagnosis and prognosis assessment in chronic coronary artery disease: stress testing with and without imaging perspective. Circ Cardiovasc Imaging 2008;1:257-269. https://doi.org/10.1161/CIRCIMAGING.108.823286
  31. Nanasato M, Morita S, Yoshida R, et al. Detection of coronary artery disease using automated quantitation of myocardial perfusion on single-photon emission computed tomography images from patients with angina pectoris without prior myocardial infarction. Circ J 2012;76:2280-2282. https://doi.org/10.1253/circj.CJ-12-0701
  32. Mahajan N, Polavaram L, Vankayala H, et al. Diagnostic accuracy of myocardial perfusion imaging and stress echocardiography for the diagnosis of left main and triple vessel coronary artery disease: a comparative meta-analysis. Heart 2010;96:956-966. https://doi.org/10.1136/hrt.2009.182295
  33. Jaarsma C, Leiner T, Bekkers SC, et al. Diagnostic performance of noninvasive myocardial perfusion imaging using single- photon emission computed tomography, cardiac magnetic resonance, and positron emission tomography imaging for the detection of obstructive coronary artery disease: a metaanalysis. J Am Coll Cardiol 2012;59:1719-1728. https://doi.org/10.1016/j.jacc.2011.12.040
  34. Min JK, Leipsic J, Pencina MJ, et al. Diagnostic accuracy of fractional flow reserve from anatomic CT angiography. JAMA 2012;308:1237-1245. https://doi.org/10.1001/2012.jama.11274
  35. Ko BS, Cameron JD, Meredith IT, et al. Computed tomography stress myocardial perfusion imaging in patients considered for revascularization: a comparison with fractional flow reserve. Eur Heart J 2012;33:67-77. https://doi.org/10.1093/eurheartj/ehr268
  36. Ferket BS, Genders TS, Colkesen EB, et al. Systematic review of guidelines on imaging of asymptomatic coronary artery disease. J Am Coll Cardiol 2011;57:1591-1600. https://doi.org/10.1016/j.jacc.2010.10.055
  37. Schwartz L, Bertolet M, Feit F, et al. Impact of completeness of revascularization on long-term cardiovascular outcomes in patients with type 2 diabetes mellitus: results from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D). Circ Cardiovas Interv 2012;5:166-173. https://doi.org/10.1161/CIRCINTERVENTIONS.111.963512
  38. Ko BS, Cameron JD, Defrance T, Seneviratne SK. CT stress myocardial perfusion imaging using multidetector CT‒a review. J Cardiovasc Comput Tomogr 2011;5:345-356. https://doi.org/10.1016/j.jcct.2011.10.005
  39. Dwivedi G, Dowsley TF, Chow BJ. Assessment of cardiac computed tomography-myocardial perfusion imaging - promise and challenges. Circ J 2012;76:544-552. https://doi.org/10.1253/circj.CJ-11-1427
  40. Pijls NH, Van Gelder B, Van der Voort P, et al. Fractional flow reserve. A useful index to evaluate the influence of an epicardial coronary stenosis on myocardial blood flow. Circulation 1995;92:3183-3193. https://doi.org/10.1161/01.CIR.92.11.3183
  41. De Bruyne B, Bartunek J, Sys SU, Heyndrickx GR. Relation between myocardial fractional flow reserve calculated from coronary pressure measurements and exercise-induced myocardial ischemia. Circulation 1995;92:39-46. https://doi.org/10.1161/01.CIR.92.1.39
  42. Fearon WF. Physiologic approach for coronary intervention. Korean J Intern Med 2013;28:1-7. https://doi.org/10.3904/kjim.2013.28.1.1
  43. Pijls NH, De Bruyne B, Peels K, et al. Measurement of fractional flow reserve to assess the functional severity of coronary- artery stenoses. N Engl J Med 1996;334:1703-1708. https://doi.org/10.1056/NEJM199606273342604
  44. Bartunek J, Van Schuerbeeck E, de Bruyne B. Comparison of exercise electrocardiography and dobutamine echocardiography with invasively assessed myocardial fractional flow reserve in evaluation of severity of coronary arterial narrowing. Am J Cardiol 1997;79:478-481. https://doi.org/10.1016/S0002-9149(96)00788-6
  45. Chamuleau SA, Meuwissen M, van Eck-Smit BL, et al. Fractional flow reserve, absolute and relative coronary blood flow velocity reserve in relation to the results of technetium-99m sestamibi single-photon emission computed tomography in patients with two-vessel coronary artery disease. J Am Coll Cardiol 2001;37:1316-1322. https://doi.org/10.1016/S0735-1097(01)01173-1
  46. Caymaz O, Fak AS, Tezcan H, et al. Correlation of myocardial fractional flow reserve with thallium-201 SPECT imaging in intermediate-severity coronary artery lesions. J Invasive Cardiol 2000;12:345-350.
  47. Jimenez-Navarro M, Alonso-Briales JH, Hernandez Garcia MJ, Rodriguez Bailon I, Gomez-Doblas JJ, de Teresa Galvan E. Measurement of fractional flow reserve to assess moderately severe coronary lesions: correlation with dobutamine stress echocardiography. J Interv Cardiol 2001;14:499-504. https://doi.org/10.1111/j.1540-8183.2001.tb00365.x
  48. Usui Y, Chikamori T, Yanagisawa H, et al. Reliability of pressure- derived myocardial fractional flow reserve in assessing coronary artery stenosis in patients with previous myocardial infarction. Am J Cardiol 2003;92:699-702. https://doi.org/10.1016/S0002-9149(03)00829-4
  49. Yanagisawa H, Chikamori T, Tanaka N, et al. Correlation between thallium-201 myocardial perfusion defects and the functional severity of coronary artery stenosis as assessed by pressure-derived myocardial fractional flow reserve. Circ J 2002;66:1105-1109. https://doi.org/10.1253/circj.66.1105
  50. Meuwissen M, Chamuleau SA, Siebes M, et al. The prognostic value of combined intracoronary pressure and blood flow velocity measurements after deferral of percutaneous coronary intervention. Catheter Cardiovasc Interv 2008;71:291-297. https://doi.org/10.1002/ccd.21331
  51. De Bruyne B, Pijls NH, Bartunek J, et al. Fractional flow reserve in patients with prior myocardial infarction. Circulation 2001;104:157-162. https://doi.org/10.1161/01.CIR.104.2.157
  52. Samady H, Lepper W, Powers ER, et al. Fractional flow reserve of infarct-related arteries identifies reversible defects on noninvasive myocardial perfusion imaging early after myocardial infarction. J Am Coll Cardiol 2006;47:2187-2193. https://doi.org/10.1016/j.jacc.2006.01.065
  53. Metz LD, Beattie M, Hom R, Redberg RF, Grady D, Fleischmann KE. The prognostic value of normal exercise myocardial perfusion imaging and exercise echocardiography: a meta-analysis. J Am Coll Cardiol 2007;49:227-237. https://doi.org/10.1016/j.jacc.2006.08.048
  54. Pijls NH, van Schaardenburgh P, Manoharan G, et al. Percutaneous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER Study. J Am Coll Cardiol 2007;49:2105-2111. https://doi.org/10.1016/j.jacc.2007.01.087
  55. Pijls NH, Fearon WF, Tonino PA, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease: 2-Year Follow-Up of the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) study. J Am Coll Cardiol 2010;56:177-184. https://doi.org/10.1016/j.jacc.2010.04.012
  56. Davies RF, Goldberg AD, Forman S, et al. Asymptomatic Cardiac Ischemia Pilot (ACIP) study two-year follow-up: outcomes of patients randomized to initial strategies of medical therapy versus revascularization. Circulation 1997;95:2037-2043. https://doi.org/10.1161/01.CIR.95.8.2037
  57. Berger A, Botman KJ, MacCarthy PA, et al. Long-term clinical outcome after fractional flow reserve-guided percutaneous coronary intervention in patients with multivessel disease. J Am Coll Cardiol 2005;46:438-442. https://doi.org/10.1016/j.jacc.2005.04.041
  58. Wongpraparut N, Yalamanchili V, Pasnoori V, et al. Thirtymonth outcome after fractional flow reserve-guided versus conventional multivessel percutaneous coronary intervention. Am J Cardiol 2005;96:877-884. https://doi.org/10.1016/j.amjcard.2005.05.040
  59. Tonino PA, De Bruyne B, Pijls NH, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 2009;360:213-224. https://doi.org/10.1056/NEJMoa0807611
  60. Fearon WF, Bornschein B, Tonino PA, et al. Economic evaluation of fractional flow reserve-guided percutaneous coronary intervention in patients with multivessel disease. Circulation 2010;122:2545-2550. https://doi.org/10.1161/CIRCULATIONAHA.109.925396
  61. De Bruyne B, Pijls NH, Kalesan B, et al. Fractional flow reserve- guided PCI versus medical therapy in stable coronary disease. N Engl J Med 2012;367:991-1001. https://doi.org/10.1056/NEJMoa1205361
  62. Hamilos M, Muller O, Cuisset T, et al. Long-term clinical outcome after fractional flow reserve-guided treatment in patients with angiographically equivocal left main coronary artery stenosis. Circulation 2009;120:1505-1512. https://doi.org/10.1161/CIRCULATIONAHA.109.850073
  63. Jasti V, Ivan E, Yalamanchili V, Wongpraparut N, Leesar MA. Correlations between fractional flow reserve and intravascular ultrasound in patients with an ambiguous left main coronary artery stenosis. Circulation 2004;110:2831-2836. https://doi.org/10.1161/01.CIR.0000146338.62813.E7
  64. Kim YH, Ahn JM, Park DW, et al. Impact of ischemia-guided revascularization with myocardial perfusion imaging for patients with multivessel coronary disease. J Am Coll Cardiol 2012;60:181-190. https://doi.org/10.1016/j.jacc.2012.02.061
  65. Yamauchi T, Tamaki N, Kasanuki H, et al. Optimal initial diagnostic strategies for the evaluation of stable angina patients: a multicenter, prospective study on myocardial perfusion imaging, computed tomographic angiography, and coronary angiography. Circ J 2012;76:2832-2839. https://doi.org/10.1253/circj.CJ-12-0222
  66. Kim YH, Park DW, Lee JY, et al. Impact of angiographic complete revascularization after drug-eluting stent implantation or coronary artery bypass graft surgery for multivessel coronary artery disease. Circulation 2011;123:2373-2381. https://doi.org/10.1161/CIRCULATIONAHA.110.005041