BACKGROUND: Whether patency of a second diseased vessel still impacts myocardial perfusion when complete revascularization of the left anterior descending coronary artery (LAD) territory has been achieved is currently undetermined. In patients with 2-vessel coronary artery disease and complex LAD lesions, we evaluated the impact of single LAD or integrated revascularization on single photon emission computed tomography-assessed reversible myocardial ischemia. METHODS AND RESULTS: Thirty-five candidates for revascularization with double-vessel disease including the LAD and a preoperative stress single photon emission computed tomography study were studied. Revascularization was performed by minimally invasive direct coronary artery bypass (MIDCAB) alone (n = 15) or by an integrated procedure with second-vessel angioplasty, either soon after surgery (n = 13) or at 2 months (n = 7), according to the extent of reversible perfusion defects in the second vessel territory. At 1 year, the total ischemic area decreased from 9.3 +/- 5.1 to 0.8 +/- 1.5 in MIDCAB-only patients and from 8.2 +/- 4.9 to 1.6 +/- 2.9 in the integrated group (P = .87 for treatment and P < .001 for time). The ischemic area in the second vessel territory similarly decreased in both groups (P = .81 for treatment and P < .001 for time). CONCLUSIONS: In 2-vessel coronary artery disease involving the LAD, MIDCAB alone achieves, in a substantial proportion of patients, functionally complete revascularization even in the nonrevascularized second vessel territory.
BACKGROUND: Whether patency of a second diseased vessel still impacts myocardial perfusion when complete revascularization of the left anterior descending coronary artery (LAD) territory has been achieved is currently undetermined. In patients with 2-vessel coronary artery disease and complex LAD lesions, we evaluated the impact of single LAD or integrated revascularization on single photon emission computed tomography-assessed reversible myocardial ischemia. METHODS AND RESULTS: Thirty-five candidates for revascularization with double-vessel disease including the LAD and a preoperative stress single photon emission computed tomography study were studied. Revascularization was performed by minimally invasive direct coronary artery bypass (MIDCAB) alone (n = 15) or by an integrated procedure with second-vessel angioplasty, either soon after surgery (n = 13) or at 2 months (n = 7), according to the extent of reversible perfusion defects in the second vessel territory. At 1 year, the total ischemic area decreased from 9.3 +/- 5.1 to 0.8 +/- 1.5 in MIDCAB-only patients and from 8.2 +/- 4.9 to 1.6 +/- 2.9 in the integrated group (P = .87 for treatment and P < .001 for time). The ischemic area in the second vessel territory similarly decreased in both groups (P = .81 for treatment and P < .001 for time). CONCLUSIONS: In 2-vessel coronary artery disease involving the LAD, MIDCAB alone achieves, in a substantial proportion of patients, functionally complete revascularization even in the nonrevascularized second vessel territory.
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Authors: Thomas J Vander Salm; Kevin E Kip; Robert H Jones; Hartzell V Schaff; Richard J Shemin; Gabriel S Aldea; Katherine M Detre Journal: J Am Coll Cardiol Date: 2002-02-20 Impact factor: 24.094
Authors: Marcel J B M van den Brand; Benno J W M Rensing; Marie-angèle M Morel; David P Foley; Vincent de Valk; Arno Breeman; Harry Suryapranata; Maximiliaan M P Haalebos; William Wijns; Francis Wellens; Rafael Balcon; Patrick Magee; Expedito Ribeiro; Enio Buffolo; Felix Unger; Patrick W Serruys Journal: J Am Coll Cardiol Date: 2002-02-20 Impact factor: 24.094
Authors: A M Calafiore; G Teodori; G Di Giammarco; G Vitolla; A Iaco'; T Iovino; S Cirmeni; G Bosco; G Scipioni; S Gallina Journal: Ann Thorac Surg Date: 1997-06 Impact factor: 4.330
Authors: T Wittwer; J Cremer; P Boonstra; J Grandjean; M Mariani; A Mügge; H Drexler; P den Heijer; E R Leitner; A Hepp; M Wehr; A Haverich Journal: Heart Date: 2000-01 Impact factor: 5.994
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Authors: G W Roach; M Kanchuger; C M Mangano; M Newman; N Nussmeier; R Wolman; A Aggarwal; K Marschall; S H Graham; C Ley Journal: N Engl J Med Date: 1996-12-19 Impact factor: 91.245
Authors: O Parodi; C Marcassa; R Casucci; G Sambuceti; E Verna; M Galli; E Inglese; P Marzullo; S Pirelli; G Bisi Journal: J Am Coll Cardiol Date: 1991-11-15 Impact factor: 24.094