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Identification of Coronary Artery Side Branch Supplying Myocardial Mass That May Benefit From Revascularization

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dc.contributor.authorKim, HY-
dc.contributor.authorDoh, JH-
dc.contributor.authorLim, HS-
dc.contributor.authorNam, CW-
dc.contributor.authorShin, ES-
dc.contributor.authorKoo, BK-
dc.contributor.authorLee, JM-
dc.contributor.authorPark, TK-
dc.contributor.authorYang, JH-
dc.contributor.authorSong, YB-
dc.contributor.authorHahn, JY-
dc.contributor.authorChoi, SH-
dc.contributor.authorGwon, HC-
dc.contributor.authorLee, SH-
dc.contributor.authorKim, SM-
dc.contributor.authorChoe, Y-
dc.contributor.authorChoi, JH-
dc.date.accessioned2018-08-24T01:48:44Z-
dc.date.available2018-08-24T01:48:44Z-
dc.date.issued2017-
dc.identifier.issn1936-8798-
dc.identifier.urihttp://repository.ajou.ac.kr/handle/201003/15890-
dc.description.abstractOBJECTIVES: The authors sought to identify whether a coronary side branch (SB) is supplying a myocardial mass that may benefit from revascularization.
BACKGROUND: The amount of subtending myocardium and physiological stenosis is frequently different between the main vessel (MV) and SB.
METHODS: In this multicenter registry, 482 patients who underwent coronary computed tomography angiography and fractional flow reserve (FFR) measurement were enrolled. The % fractional myocardial mass (FMM), the ratio of vessel-specific myocardial mass to whole myocardium, was assessed in 5,860 MV or SB consisting of 2,930 bifurcations. Physiological stenosis was defined by fractional flow reserve (FFR) <0.80. Myocardial mass that may benefit from revascularization was defined by %FMM >/=10%.
RESULTS: In per-bifurcation analysis, MV supplied a 1.5- to 9-fold larger myocardial mass compared with SB. Unlike left main bifurcation (n = 482), only 1 of every 5 non-left main SB (n = 2,448) supplied %FMM >/=10% (97% vs. 21%: p < 0.001). SB length >/=73 mm could estimate %FMM >/=10% (c-statistic = 0.85: p < 0.001). In 604 vessels interrogated by FFR, diameter stenosis was similar (p = NS), but %FMM >/=10%, FMM/minimal luminal diameter, and frequency of FFR <0.80 was higher in MV compared with SB (p < 0.001, all). Generalized estimating equations modeling demonstrate that vessel diameter, left myocardial mass, and FFR were not (p = NS), but SB length >/=73 mm and left main bifurcation were significant predictors for %FMM >/=10% (p < 0.001).
CONCLUSIONS: Compared with MV, SB supplies a smaller myocardial mass and showed less physiological severity despite similar stenosis severity. SB supplying a myocardial mass of %FMM>/=10%, which may benefit revascularization could be identified by vessel length >/=73 mm. Pre-procedural recognition of these findings may guide optimal revascularization strategy for bifurcation.
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dc.language.isoen-
dc.subject.MESHAged-
dc.subject.MESHArea Under Curve-
dc.subject.MESHComputed Tomography Angiography-
dc.subject.MESHCoronary Angiography-
dc.subject.MESHCoronary Artery Disease-
dc.subject.MESHCoronary Stenosis-
dc.subject.MESHCoronary Vessels-
dc.subject.MESHFemale-
dc.subject.MESHFractional Flow Reserve, Myocardial-
dc.subject.MESHHumans-
dc.subject.MESHMale-
dc.subject.MESHMiddle Aged-
dc.subject.MESHMultidetector Computed Tomography-
dc.subject.MESHMyocardial Revascularization-
dc.subject.MESHPredictive Value of Tests-
dc.subject.MESHROC Curve-
dc.subject.MESHRegistries-
dc.subject.MESHRepublic of Korea-
dc.subject.MESHSeverity of Illness Index-
dc.titleIdentification of Coronary Artery Side Branch Supplying Myocardial Mass That May Benefit From Revascularization-
dc.typeArticle-
dc.identifier.pmid28259665-
dc.contributor.affiliatedAuthor임, 홍석-
dc.type.localJournal Papers-
dc.identifier.doi10.1016/j.jcin.2016.11.033-
dc.citation.titleJACC. Cardiovascular interventions-
dc.citation.volume10-
dc.citation.number6-
dc.citation.date2017-
dc.citation.startPage571-
dc.citation.endPage581-
dc.identifier.bibliographicCitationJACC. Cardiovascular interventions, 10(6). : 571-581, 2017-
dc.embargo.liftdate9999-12-31-
dc.embargo.terms9999-12-31-
dc.identifier.eissn1876-7605-
dc.relation.journalidJ019368798-
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Cardiology
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