Background: Patients with ischemic heart disease and reduced ejection fraction have increased risk for postoperative complications and mortality. Our aim was to evaluate the effect of low EF (on the early outcomes aft...Background: Patients with ischemic heart disease and reduced ejection fraction have increased risk for postoperative complications and mortality. Our aim was to evaluate the effect of low EF (on the early outcomes after CABG and identify the predictors of mortality. Methods: From August 2018 to November 2019, 170 consecutive patients underwent CABG. Group 1 included 120 patients with EF ( EF (>40;57.90% ± 2.27%), 41 were men (82.0%), and the mean age was 54.30 ± 7.01 years and used as a control group. Results: Overall 30-day mortality was 10/120 patients (8.3%). Factors associated with higher mortality were females (70.0% vs. 17.3%, P Conclusion: CABG in EF < 40% is associated with more complications compared with those had EF higher than 40%;however, the clinical and echocardiographic parameters improved over time.展开更多
The data about FFR-guided revascularization in isolated proximal LAD disease are limited and studies comparing long-term outcomes of FFR-guided PCI versus FFR-guided CABG in single-vessel proximal LAD disease are lack...The data about FFR-guided revascularization in isolated proximal LAD disease are limited and studies comparing long-term outcomes of FFR-guided PCI versus FFR-guided CABG in single-vessel proximal LAD disease are lacking. We aimed to assess the 4-year long-term safety and effectiveness of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) and FFR-guided coronary artery bypass graft surgery (CABG) for the treatment of proximal left anterior descending (LAD) lesions. The study included 129 patients with functionally significant (FFR ≤ 0.80) isolated proximal LAD stenosis (PCI, 88 patients vs. CABG, 41). Clinical endpoints were assessed by Kaplan-Meier method and compared by the log-rank test. At a mean follow-up time of 47 ± 12 months, a higher incidence of myocardial infarction in the PCI group (PCI: 32% vs. CABG: 15%;p = 0.003) and a higher incidence of stroke in the CABG group (CABG: 3 (7%) vs. PCI 0 (0%);p = 0.031) were observed. However, there were no significant differences in the primary composite endpoint, death and target vessel revascularization between PCI and CABG groups. The PCI and CABG in isolated proximal LAD lesions yielded similar long-term outcomes regarding the primary composite clinical endpoints. However, stroke was more frequent in the CABG group than in the PCI group.展开更多
Flow fractional reserve(FFR) allows to evaluate the functional significance of coronary artery lesions, through the ratio of the mean coronary artery pressure after the stenosis to the mean aortic pressure duringmaxim...Flow fractional reserve(FFR) allows to evaluate the functional significance of coronary artery lesions, through the ratio of the mean coronary artery pressure after the stenosis to the mean aortic pressure duringmaximum hyperemia. The actual widely accepted cutoff value is 0.80. Below this value a coronary lesion is considered significant and therefore it requires invasive revascularization. Several studies [in particular Fractional Flow Reserve vs Angiography for Multivessel Evaluation 1(FAME-1) and FAME-2] have shown the relationship between FFR measurement and hard end-points(death, myocardial infarction, and urgent revascularization). Consequently, FFR evaluation represents the cornerstone in the decision-making in intermediate coronary lesions. Recent studies paved the way for further applications of FFR evaluation in complex and tricky clinical settings. In this paper, we perform an overview of the data regarding contemporary application of FFR. In particular, we review the use of FFR in: left main intermediate stenoses, serial stenoses, evaluation after stenting, guidance in coronary artery bypass surgery, and acute coronary syndrome. All the data presented in our overview confirm the essential role of FFR assessment in the daily clinical practice. The shift from "operator-dependent" to "FFR-dependent" evaluation in intermediate coronary artery stenosis is of paramount importance in order to improve the prognosis of our patients, through the discrimination of the functional role of every single coronary stenosis.展开更多
文摘Background: Patients with ischemic heart disease and reduced ejection fraction have increased risk for postoperative complications and mortality. Our aim was to evaluate the effect of low EF (on the early outcomes after CABG and identify the predictors of mortality. Methods: From August 2018 to November 2019, 170 consecutive patients underwent CABG. Group 1 included 120 patients with EF ( EF (>40;57.90% ± 2.27%), 41 were men (82.0%), and the mean age was 54.30 ± 7.01 years and used as a control group. Results: Overall 30-day mortality was 10/120 patients (8.3%). Factors associated with higher mortality were females (70.0% vs. 17.3%, P Conclusion: CABG in EF < 40% is associated with more complications compared with those had EF higher than 40%;however, the clinical and echocardiographic parameters improved over time.
文摘The data about FFR-guided revascularization in isolated proximal LAD disease are limited and studies comparing long-term outcomes of FFR-guided PCI versus FFR-guided CABG in single-vessel proximal LAD disease are lacking. We aimed to assess the 4-year long-term safety and effectiveness of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) and FFR-guided coronary artery bypass graft surgery (CABG) for the treatment of proximal left anterior descending (LAD) lesions. The study included 129 patients with functionally significant (FFR ≤ 0.80) isolated proximal LAD stenosis (PCI, 88 patients vs. CABG, 41). Clinical endpoints were assessed by Kaplan-Meier method and compared by the log-rank test. At a mean follow-up time of 47 ± 12 months, a higher incidence of myocardial infarction in the PCI group (PCI: 32% vs. CABG: 15%;p = 0.003) and a higher incidence of stroke in the CABG group (CABG: 3 (7%) vs. PCI 0 (0%);p = 0.031) were observed. However, there were no significant differences in the primary composite endpoint, death and target vessel revascularization between PCI and CABG groups. The PCI and CABG in isolated proximal LAD lesions yielded similar long-term outcomes regarding the primary composite clinical endpoints. However, stroke was more frequent in the CABG group than in the PCI group.
文摘Flow fractional reserve(FFR) allows to evaluate the functional significance of coronary artery lesions, through the ratio of the mean coronary artery pressure after the stenosis to the mean aortic pressure duringmaximum hyperemia. The actual widely accepted cutoff value is 0.80. Below this value a coronary lesion is considered significant and therefore it requires invasive revascularization. Several studies [in particular Fractional Flow Reserve vs Angiography for Multivessel Evaluation 1(FAME-1) and FAME-2] have shown the relationship between FFR measurement and hard end-points(death, myocardial infarction, and urgent revascularization). Consequently, FFR evaluation represents the cornerstone in the decision-making in intermediate coronary lesions. Recent studies paved the way for further applications of FFR evaluation in complex and tricky clinical settings. In this paper, we perform an overview of the data regarding contemporary application of FFR. In particular, we review the use of FFR in: left main intermediate stenoses, serial stenoses, evaluation after stenting, guidance in coronary artery bypass surgery, and acute coronary syndrome. All the data presented in our overview confirm the essential role of FFR assessment in the daily clinical practice. The shift from "operator-dependent" to "FFR-dependent" evaluation in intermediate coronary artery stenosis is of paramount importance in order to improve the prognosis of our patients, through the discrimination of the functional role of every single coronary stenosis.
