The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Percutaneous coronary intervention in patients with multi-vessel coronary artery disease: a focus on physiology

  • Cho, Yun-Kyeong (Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center) ;
  • Nam, Chang-Wook (Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center)
  • Received : 2018.01.05
  • Accepted : 2018.01.16
  • Published : 2018.09.01
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Abstract

Multi-vessel coronary artery disease (MVD) frequently features ambiguous or intermediate lesions that may be both serial and complex, suggesting that multiple regions require revascularization. Percutaneous coronary intervention (PCI) is associated with various challenges such as appropriate identification of lesions that should be treated, the choice of an optimum revascularization method, and limitations of long-term outcomes. Optimal patient selection and careful targeting of lesions are key when planning treatment. Physiology-guided decision-making (based on the fractional flow reserve) can overcome the current limitations of PCI used to treat MVD regardless of clinical presentation or disease subtype, as confirmed in recent clinical trials. Here, we review the use of physiology-guided PCI for patients with MVD, and their early and late outcomes.

Keywords

References

  1. Mabin TA, Holmes DR Jr, Smith HC, et al. Follow-up clinical results in patients undergoing percutaneous transluminal coronary angioplasty. Circulation 1985;71:754-760. https://doi.org/10.1161/01.CIR.71.4.754
  2. Corpus RA, House JA, Marso SP, et al. Multivessel percutaneous coronary intervention in patients with multivessel disease and acute myocardial infarction. Am Heart J 2004;148:493-500. https://doi.org/10.1016/j.ahj.2004.03.051
  3. Min JK, Shaw LJ, Devereux RB, et al. Prognostic value of multidetector coronary computed tomographic angiography for prediction of all-cause mortality. J Am Coll Cardiol 2007;50:1161-1170. https://doi.org/10.1016/j.jacc.2007.03.067
  4. 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
  5. Levine GN, Bates ER, Blankenship JC, et al. 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol 2011;58:e44-e122. https://doi.org/10.1016/j.jacc.2011.08.007
  6. Authors/Task Force members, Windecker S, Kolh P, et al. 2014 ESC/EACTS guidelines on myocardial revascularization: the task force on myocardial revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2014;35:2541-2619. https://doi.org/10.1093/eurheartj/ehu278
  7. Bypass Angioplasty Revascularization Investigation (BARI) Investigators. Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease. N Engl J Med 1996;335:217-225. https://doi.org/10.1056/NEJM199607253350401
  8. BARI Investigators. The final 10-year follow-up results from the BARI randomized trial. J Am Coll Cardiol 2007;49:1600-1606. https://doi.org/10.1016/j.jacc.2006.11.048
  9. Serruys PW, Unger F, Sousa JE, et al. Comparison of coronary-artery bypass surgery and stenting for the treatment of multivessel disease. N Engl J Med 2001;344:1117-1124. https://doi.org/10.1056/NEJM200104123441502
  10. Serruys PW, Ong AT, van Herwerden LA, et al. Five-year outcomes after coronary stenting versus bypass surgery for the treatment of multivessel disease: the final analysis of the Arterial Revascularization Therapies Study (ARTS) randomized trial. J Am Coll Cardiol 2005;46:575-581. https://doi.org/10.1016/j.jacc.2004.12.082
  11. 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
  12. Head SJ, Davierwala PM, Serruys PW, et al. Coronary artery bypass grafting vs. percutaneous coronary intervention for patients with three-vessel disease: final five-year follow-up of the SYNTAX trial. Eur Heart J 2014;35:2821-2830. https://doi.org/10.1093/eurheartj/ehu213
  13. Park SJ, Ahn JM, Kim YH, et al. Trial of everolimus-eluting stents or bypass surgery for coronary disease. N Engl J Med 2015;372:1204-1212. https://doi.org/10.1056/NEJMoa1415447
  14. Gersh BJ, Frye RL. Methods of coronary revascularization: things may not be as they seem. N Engl J Med 2005;352:2235-2237. https://doi.org/10.1056/NEJMe058053
  15. Cho YK, Nam CW, Han JK, et al. Usefulness of combined intravascular ultrasound parameters to predict functional significance of coronary artery stenosis and determinants of mismatch. EuroIntervention 2015;11:163-170. https://doi.org/10.4244/EIJV11I2A30
  16. 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
  17. 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
  18. 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
  19. van Nunen LX, Zimmermann FM, Tonino PA, et al. Fractional flow reserve versus angiography for guidance of PCI in patients with multivessel coronary artery disease (FAME): 5-year follow-up of a randomised controlled trial. Lancet 2015;386:1853-1860. https://doi.org/10.1016/S0140-6736(15)00057-4
  20. 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
  21. Nam CW, Mangiacapra F, Entjes R, et al. Functional SYNTAX score for risk assessment in multivessel coronary artery disease. J Am Coll Cardiol 2011;58:1211-1218. https://doi.org/10.1016/j.jacc.2011.06.020
  22. Nam CW, Fearon WF. Role of the functional SYNTAX score in evaluating multivessel coronary artery disease. Interv Cardiol 2011;3:695-704. https://doi.org/10.2217/ica.11.77
  23. Farooq V, Serruys PW, Bourantas CV, et al. Quantification of incomplete revascularization and its association with five-year mortality in the synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) trial validation of the residual SYNTAX score. Circulation 2013;128:141-151. https://doi.org/10.1161/CIRCULATIONAHA.113.001803
  24. Choi KH, Lee JM, Koo B-K, et al. TCT-333 Prognostic implication of functional incomplete revascularization and residual functional SYNTAX score in patients with coronary artery disease. J Am Coll Cardiol 2017;70(18 Suppl):B137.
  25. Ahn JM, Park DW, Lee CW, et al. Comparison of stenting versus bypass surgery according to the completeness of revascularization in severe coronary artery disease: patient-level pooled analysis of the SYNTAX, PRECOMBAT, and BEST trials. JACC Cardiovasc Interv 2017;10:1415-1424. https://doi.org/10.1016/j.jcin.2017.04.037
  26. Kobayashi Y, Nam CW, Tonino PA, et al. The prognostic value of residual coronary stenoses after functionally complete revascularization. J Am Coll Cardiol 2016;67:1701-1711.
  27. Tamita K, Akasaka T, Takagi T, et al. Effects of microvascular dysfunction on myocardial fractional flow reserve after percutaneous coronary intervention in patients with acute myocardial infarction. Catheter Cardiovasc Interv 2002;57:452-459. https://doi.org/10.1002/ccd.10350
  28. Layland J, Oldroyd KG, Curzen N, et al. Fractional flow reserve vs. angiography in guiding management to optimize outcomes in non-ST-segment elevation myocardial infarction: the British Heart Foundation FAMOUS-NSTEMI randomized trial. Eur Heart J 2015;36:100-111. https://doi.org/10.1093/eurheartj/ehu338
  29. Ntalianis A, Sels JW, Davidavicius G, et al. Fractional flow reserve for the assessment of nonculprit coronary artery stenosis in patients with acute myocardial infarction. JACC Cardiovasc Interv 2010;3:1274-1281. https://doi.org/10.1016/j.jcin.2010.08.025
  30. Engstrom T, Kelbaek H, Helqvist S, et al. Complete revascularisation versus treatment of the culprit lesion only in patients with ST-segment elevation myocardial infarction and multivessel disease (DANAMI-3-PRIMULTI): an open-label, randomized controlled trial. Lancet 2015;386:665-671. https://doi.org/10.1016/S0140-6736(15)60648-1
  31. Smits PC, Abdel-Wahab M, Neumann FJ, et al. Fractional flow reserve-guided multivessel angioplasty in myocardial infarction. N Engl J Med 2017;376:1234-1244. https://doi.org/10.1056/NEJMoa1701067

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