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 Arnold, Theodoros Karamitsos, William van Gaal, Luca Testa, Jane Francis, Paul Bhamra-Ariza, Ali Ali, Joseph Selvanayagam, S Westaby, Rana Sayeed, Michael Jerosch-Herold, Stefan Neubauer, Adrian Banning

    Research output: Contribution to journalArticlepeer-review

    9 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.

    Original languageEnglish
    Pages (from-to)237-245
    Number of pages9
    JournalCirculation: Cardiovascular Interventions
    Volume6
    Issue number3
    DOIs
    Publication statusPublished - Jun 2013

    Keywords

    • Bypass surgery
    • Revascularization
    • Stent

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