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- Title
Instantaneous wave free ratio value impact on left internal mammary artery graft patency.
- Authors
Ordiene, Rasa; Unikas, Ramunas; Aldujeli, Ali; Benetis, Rimantas; Jakuska, Povilas; Ceponiene, Indre; Jankauskas, Antanas; Plisiene, Jurgita; Lenkutis, Tadas; Rudokaite, Gabriele; Braukyliene, Rima; Stonis, Mindaugas; Davies, Justin; Punjabi, Prakash P
- Abstract
Objectives: To assess whether instantaneous wave – free ratio (iFR) value is associated with left internal mammary artery (LIMA) graft failure at 12 months follow-up post coronary artery bypass graft (CABG). Background: Data suggests bypass to a non-significant left anterior descending artery (LAD) lesion due to visual over-estimation may lead to LIMA graft failure. Implementing iFR may result in better arterial graft patency. Methods: In iCABG (iFR guided CABG) study patients planned to undergo an isolated CABG procedure was prospectively enrolled and iFR was performed for LAD. Coronary computed tomography angiography was performed at 2 and 12 months follow-up. The primary endpoint of this study was to determine the rate of LIMA graft occlusion or hypoperfusion at 2 and 12-months follow-up. We considered a composite secondary endpoint of Major adverse cardiovascular and cerebrovascular event (MACCE) as a secondary outcome. Results: In total 69 patients were included with no differences regarding age, sex and risk factors. At 2 months, 50 of LIMAs with pre-CABG iFR median 0.855 (0.785 – 0.892) were patent. Hypoperfusion was found in 8 LIMAs (median iFR 0.88 (0.842 – 0.90)). While, 7 LIMAs (median iFR 0.91 (0.88 – 0.96)) were occluded (p = 0.04). At 12 months, when iFR of LAD was >0.85: just 12 (31.6% out of all patent LIMAS) grafts were patent and 24 (100.0% out of all hypoperfused/occluded) grafts were hypoperfused or occluded (p < 0.001). In terms of MACCE, no difference (p = 1.0) was found between all 3 groups divided according to iFR value. Conclusions: Instantaneous wave – free ratio value above 0.85 in LAD is a powerful tool predicting LIMA graft failure at 1-year follow up period.
- Subjects
PATIENT aftercare; KRUSKAL-Wallis Test; CORONARY artery bypass; GRAFT rejection; BLOOD vessels; MAJOR adverse cardiovascular events; SURGICAL complications; MANN Whitney U Test; CORONARY circulation; VASCULAR grafts; SEVERITY of illness index; INTERNAL thoracic artery; BLIND experiment; DESCRIPTIVE statistics; CORONARY arteries; COMPUTED tomography; DATA analysis software; RECEIVER operating characteristic curves; LOGISTIC regression analysis; LONGITUDINAL method; PERFUSION; PROBABILITY theory
- Publication
Perfusion, 2023, Vol 38, Issue 6, p1230
- ISSN
0267-6591
- Publication type
Article
- DOI
10.1177/02676591221099808