Lots of interesting abstracts and cases were submitted for TCTAP & AP VALVES 2020 Virtual. Below are accepted ones after thoroughly reviewed by our official reviewers. Don¡¯t miss the opportunity to explore your knowledge and interact with authors as well as virtual participants by sharing your opinion!
* The E-Science Station is well-optimized for PC.
We highly recommend you use a desktop computer or laptop to browse E-posters.
ABS20191031_0007
| Peripheral Vascular Disease and Intervention | |
| Pre-Op Diagnosis of Lesion-Specific Ischemia Using CT-Derived Fractional Flow Reserve (FFRCT) May Reduce Post-Op MI and Death in Patients Undergoing Peripheral Vascular Surgery | |
| Dainis Krievins1, Edgars Zellans1, Karlis Kaufmanis2, Gustavs Latkovskis1, Indulis Kumsars3, Roberts Rumba1, Ligita Zvaigzne1, Andrejs Erglis1, Christopher K. Zarins4 | |
| Pauls Stradins Clinical University Hospital, Latvia1, Pauls Stradins clinical university hospital, Latvia2, Pstradins University Hospital, Latvia3, HeartFlow Ltd., USA4 | |
|
Background:
Peripheral vascular surgery (PVS) patients have increased risk of post-op MI/death which may be due to unrecognized coronary ischemia. Coronary CT-derived fractional flow reserve (FFRCT) can identify lesion-specific ischemia in stable chest pain patients but its value in PVS is unknown. We sought to determine if pre-op FFRCT can reduce post-op cardiac events in PVS patients.
|
|
|
Methods:
PVS patients with no cardiac symptoms had pre-op CT-FFRCT in a prospective, IRB - approved Study and were compared to matched retrospective Controls who had PVS with standard pre-op testing. Lesion-specific ischemia was defined as FFRCT ¡Â 0.80 distal to stenosis. Primary endpoint was major adverse cardiac event (MACE = cardiac death, MI or urgent revascularization) at 30 days and 12 months.
|
|
|
Results:
Study (n = 135) and Control (n = 135) patients were similar in age (65 ¡¾ 8 vs 66 ¡¾ 8 years), gender (80 % v 82 % male), risk factors, pre-op ABI and surgery performed. CTA in Study showed extensive calcification (Agatston 1156 ¡¾ 1026) with left main in 7 % and ¡Ã 50 % stenosis in 70 %. Silent ischemia was present in 86/126 (68 %) Study patients; 56 % had multivessel ischemia. PVS was performed in all Controls and 130 (96 %) Study patients (5 were postponed: 1 PCI, 4 medical). No post-op deaths in Study 0 vs 5 due to MI in Control; one Study patient had post-op MI on day 3 with successful emergent PCI. MACE at 30 days in Study was 1/135 (0.7 %) vs 7/135 (5.2 %) in Control (p = 0.06). Elective coronary angiography was performed in 75 Study patients with left main, severe or multivessel ischemia 1-3 months post-op with coronary revascularization in 54 (47 stents; 7 CABG). At 12 months follow up, compared to Controls, Study patients had significant reduction in cardiac death (0 vs 4.4 %, p = 0.007), MI (2.2 vs 8.1 %, p = 0.028) and MACE (2.2 vs 8.1 %, p = 0.028).
|
|
|
Conclusion:
Asymptomatic lesion-specific ischemia is present in 2 of 3 patients undergoing peripheral vascular surgery. Pre-op CT-FFRCT diagnosis can help guide multi-disciplinary team approach to reduce post-op death/MI. Favorable results of staged peripheral and coronary revascularization at one year suggest the need for further controlled outcome studies.
|
|
0