Residual ischemia after revascularization in multivessel coronary artery disease: Insights from measurement of absolute myocardial blood flow using magnetic resonance imaging compared with angiographic assessment

Jayanth R. Arnold, Theodoros D. Karamitsos, William J. Van Gaal, Luca Testa, Jane M. Francis, Paul Bhamra-Ariza, Ali Ali, Joseph B. Selvanayagam, Steve Westaby, Rana Sayeed, Michael Jerosch-Herold, Stefan Neubauer, Adrian P. Banning

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background-Revascularization strategies for multivessel coronary artery disease include percutaneous coronary intervention and coronary artery bypass grafting. In this study, we compared the completeness of revascularization as assessed by coronary angiography and by quantitative serial perfusion imaging using cardiovascular magnetic resonance. Methods and Results-Patients with multivessel coronary disease were recruited into a randomized trial of treatment with either coronary artery bypass grafting or percutaneous coronary intervention. Angiographic disease burden was determined by the Bypass Angioplasty Revascularization Investigation (BARI) myocardial jeopardy index. Cardiovascular magnetic resonance first-pass perfusion imaging was performed before and 5 to 6 months after revascularization. Using modelindependent deconvolution, hyperemic myocardial blood flow was evaluated, and ischemic burden was quantified. Sixtyseven patients completed follow-up (33 coronary artery bypass grafting and 34 percutaneous coronary intervention). The myocardial jeopardy index was 80.7±15.2% at baseline and 6.9±11.3% after revascularization (P<0.0001), with revascularization deemed complete in 62.7% of patients. Relative to cardiovascular magnetic resonance, angiographic assessment overestimated disease burden at baseline (80.7±15.2% versus 49.9±29.2% [P<0.0001]), but underestimated it postprocedure (6.9±11.3% versus 28.1±33.4% [P<0.0001]). Fewer patients achieved complete revascularization based on functional criteria than on angiographic assessment (38.8% versus 62.7%; P=0.015). After revascularization, hyperemic myocardial blood flow was significantly higher in segments supplied by arterial bypass grafts than those supplied by venous grafts (2.04±0.82 mL/min per gram versus 1.89±0.81 mL/min per gram, respectively; P=0.04). Conclusions-Angiographic assessment may overestimate disease burden before revascularization, and underestimate residual ischemia after revascularization. Functional data demonstrate that a significant burden of ischemia remains even after angiographically defined successful revascularization.

LanguageEnglish
Pages237-245
Number of pages9
JournalCirculation: Cardiovascular Interventions
Volume6
Issue number3
DOIs
Publication statusPublished - 1 Jun 2013

Keywords

  • Bypass surgery
  • Revascularization
  • Stent

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Arnold, Jayanth R. ; Karamitsos, Theodoros D. ; Van Gaal, William J. ; Testa, Luca ; Francis, Jane M. ; Bhamra-Ariza, Paul ; Ali, Ali ; Selvanayagam, Joseph B. ; Westaby, Steve ; Sayeed, Rana ; Jerosch-Herold, Michael ; Neubauer, Stefan ; Banning, Adrian P. / Residual ischemia after revascularization in multivessel coronary artery disease : Insights from measurement of absolute myocardial blood flow using magnetic resonance imaging compared with angiographic assessment. In: Circulation: Cardiovascular Interventions. 2013 ; Vol. 6, No. 3. pp. 237-245.
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abstract = "Background-Revascularization strategies for multivessel coronary artery disease include percutaneous coronary intervention and coronary artery bypass grafting. In this study, we compared the completeness of revascularization as assessed by coronary angiography and by quantitative serial perfusion imaging using cardiovascular magnetic resonance. Methods and Results-Patients with multivessel coronary disease were recruited into a randomized trial of treatment with either coronary artery bypass grafting or percutaneous coronary intervention. Angiographic disease burden was determined by the Bypass Angioplasty Revascularization Investigation (BARI) myocardial jeopardy index. Cardiovascular magnetic resonance first-pass perfusion imaging was performed before and 5 to 6 months after revascularization. Using modelindependent deconvolution, hyperemic myocardial blood flow was evaluated, and ischemic burden was quantified. Sixtyseven patients completed follow-up (33 coronary artery bypass grafting and 34 percutaneous coronary intervention). The myocardial jeopardy index was 80.7±15.2{\%} at baseline and 6.9±11.3{\%} after revascularization (P<0.0001), with revascularization deemed complete in 62.7{\%} of patients. Relative to cardiovascular magnetic resonance, angiographic assessment overestimated disease burden at baseline (80.7±15.2{\%} versus 49.9±29.2{\%} [P<0.0001]), but underestimated it postprocedure (6.9±11.3{\%} versus 28.1±33.4{\%} [P<0.0001]). Fewer patients achieved complete revascularization based on functional criteria than on angiographic assessment (38.8{\%} versus 62.7{\%}; P=0.015). After revascularization, hyperemic myocardial blood flow was significantly higher in segments supplied by arterial bypass grafts than those supplied by venous grafts (2.04±0.82 mL/min per gram versus 1.89±0.81 mL/min per gram, respectively; P=0.04). Conclusions-Angiographic assessment may overestimate disease burden before revascularization, and underestimate residual ischemia after revascularization. Functional data demonstrate that a significant burden of ischemia remains even after angiographically defined successful revascularization.",
keywords = "Bypass surgery, Revascularization, Stent",
author = "Arnold, {Jayanth R.} and Karamitsos, {Theodoros D.} and {Van Gaal}, {William J.} and Luca Testa and Francis, {Jane M.} and Paul Bhamra-Ariza and Ali Ali and Selvanayagam, {Joseph B.} and Steve Westaby and Rana Sayeed and Michael Jerosch-Herold and Stefan Neubauer and Banning, {Adrian P.}",
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Residual ischemia after revascularization in multivessel coronary artery disease : Insights from measurement of absolute myocardial blood flow using magnetic resonance imaging compared with angiographic assessment. / Arnold, Jayanth R.; Karamitsos, Theodoros D.; Van Gaal, William J.; Testa, Luca; Francis, Jane M.; Bhamra-Ariza, Paul; Ali, Ali; Selvanayagam, Joseph B.; Westaby, Steve; Sayeed, Rana; Jerosch-Herold, Michael; Neubauer, Stefan; Banning, Adrian P.

In: Circulation: Cardiovascular Interventions, Vol. 6, No. 3, 01.06.2013, p. 237-245.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Residual ischemia after revascularization in multivessel coronary artery disease

T2 - Circulation: Cardiovascular Interventions

AU - Arnold, Jayanth R.

AU - Karamitsos, Theodoros D.

AU - Van Gaal, William J.

AU - Testa, Luca

AU - Francis, Jane M.

AU - Bhamra-Ariza, Paul

AU - Ali, Ali

AU - Selvanayagam, Joseph B.

AU - Westaby, Steve

AU - Sayeed, Rana

AU - Jerosch-Herold, Michael

AU - Neubauer, Stefan

AU - Banning, Adrian P.

PY - 2013/6/1

Y1 - 2013/6/1

N2 - Background-Revascularization strategies for multivessel coronary artery disease include percutaneous coronary intervention and coronary artery bypass grafting. In this study, we compared the completeness of revascularization as assessed by coronary angiography and by quantitative serial perfusion imaging using cardiovascular magnetic resonance. Methods and Results-Patients with multivessel coronary disease were recruited into a randomized trial of treatment with either coronary artery bypass grafting or percutaneous coronary intervention. Angiographic disease burden was determined by the Bypass Angioplasty Revascularization Investigation (BARI) myocardial jeopardy index. Cardiovascular magnetic resonance first-pass perfusion imaging was performed before and 5 to 6 months after revascularization. Using modelindependent deconvolution, hyperemic myocardial blood flow was evaluated, and ischemic burden was quantified. Sixtyseven patients completed follow-up (33 coronary artery bypass grafting and 34 percutaneous coronary intervention). The myocardial jeopardy index was 80.7±15.2% at baseline and 6.9±11.3% after revascularization (P<0.0001), with revascularization deemed complete in 62.7% of patients. Relative to cardiovascular magnetic resonance, angiographic assessment overestimated disease burden at baseline (80.7±15.2% versus 49.9±29.2% [P<0.0001]), but underestimated it postprocedure (6.9±11.3% versus 28.1±33.4% [P<0.0001]). Fewer patients achieved complete revascularization based on functional criteria than on angiographic assessment (38.8% versus 62.7%; P=0.015). After revascularization, hyperemic myocardial blood flow was significantly higher in segments supplied by arterial bypass grafts than those supplied by venous grafts (2.04±0.82 mL/min per gram versus 1.89±0.81 mL/min per gram, respectively; P=0.04). Conclusions-Angiographic assessment may overestimate disease burden before revascularization, and underestimate residual ischemia after revascularization. Functional data demonstrate that a significant burden of ischemia remains even after angiographically defined successful revascularization.

AB - Background-Revascularization strategies for multivessel coronary artery disease include percutaneous coronary intervention and coronary artery bypass grafting. In this study, we compared the completeness of revascularization as assessed by coronary angiography and by quantitative serial perfusion imaging using cardiovascular magnetic resonance. Methods and Results-Patients with multivessel coronary disease were recruited into a randomized trial of treatment with either coronary artery bypass grafting or percutaneous coronary intervention. Angiographic disease burden was determined by the Bypass Angioplasty Revascularization Investigation (BARI) myocardial jeopardy index. Cardiovascular magnetic resonance first-pass perfusion imaging was performed before and 5 to 6 months after revascularization. Using modelindependent deconvolution, hyperemic myocardial blood flow was evaluated, and ischemic burden was quantified. Sixtyseven patients completed follow-up (33 coronary artery bypass grafting and 34 percutaneous coronary intervention). The myocardial jeopardy index was 80.7±15.2% at baseline and 6.9±11.3% after revascularization (P<0.0001), with revascularization deemed complete in 62.7% of patients. Relative to cardiovascular magnetic resonance, angiographic assessment overestimated disease burden at baseline (80.7±15.2% versus 49.9±29.2% [P<0.0001]), but underestimated it postprocedure (6.9±11.3% versus 28.1±33.4% [P<0.0001]). Fewer patients achieved complete revascularization based on functional criteria than on angiographic assessment (38.8% versus 62.7%; P=0.015). After revascularization, hyperemic myocardial blood flow was significantly higher in segments supplied by arterial bypass grafts than those supplied by venous grafts (2.04±0.82 mL/min per gram versus 1.89±0.81 mL/min per gram, respectively; P=0.04). Conclusions-Angiographic assessment may overestimate disease burden before revascularization, and underestimate residual ischemia after revascularization. Functional data demonstrate that a significant burden of ischemia remains even after angiographically defined successful revascularization.

KW - Bypass surgery

KW - Revascularization

KW - Stent

UR - http://www.scopus.com/inward/record.url?scp=84884486170&partnerID=8YFLogxK

U2 - 10.1161/CIRCINTERVENTIONS.112.000064

DO - 10.1161/CIRCINTERVENTIONS.112.000064

M3 - Article

VL - 6

SP - 237

EP - 245

JO - Circulation: Cardiovascular Interventions

JF - Circulation: Cardiovascular Interventions

SN - 1941-7640

IS - 3

ER -