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!
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ABS20191101_0006
| Imaging: Non-Invasive | |
| Revascularization of Ischemia-Producing Coronary Stenosis in Patients with No Coronary Symptoms Undergoing Peripheral Vascular Surgery | |
| Indulis Kumsars1, Dainis Krievins2, Gustavs Latkovskis2, Edgars Zellans2, Roberts Rumba2, Karlis Kaufmanis3, Sanda Jegere2, Andrejs Erglis2 | |
| Pstradins University Hospital, Latvia1, Pauls Stradins Clinical University Hospital, Latvia2, Pauls Stradins clinical university hospital, Latvia3 | |
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Background:
Patients undergoing peripheral vascular surgery (PVS) have increased risk for post-op death/MI due to coronary artery disease (CAD). Non-invasive diagnosis of lesion-specific ischemia (LSI) using coronary CT-derived FFR (FFRCT) helps guide revascularization strategy in chest pain patients but its value in PVS patients with no chest symptoms is unknown.
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Methods:
PVS patients with no cardiac history or symptoms were evaluated with FFRCT in a prospective, open-label, IRB-approved study. Lesion-specific ischemia (LSI) was defined as FFRCT ¡Â0.80distal to stenosis in>2mm vessel. Primary endpoint was MACE (cardiac death, MI, urgent revascularization) at 30 days, 6and 12 months.
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Results:
Pre-op FFRCT was performed in114 consecutive patients (age 66¡¾8 years, 80% male), undergoing carotid, aorticor peripheral vascular surgery. LSI was present in 77 patients (68%) with severe ischemia in 69, left main in 9 and multivessel ischemia in 46 patients. PVS was performed as scheduled in 106 patients (93%) with no post op death/MI; PVS was postponed in 8. Post-op coronary angiography in 60 patients with LSI confirmed stenosis in all; coronary revascularization was performed in 46 patients (40 PCI; 6 CABG). During 12 month follow up there havebeen no cardiac deaths and 2 MIs; one peri-procedural (PCI) and one at 6 months (urgent PCI). MACE at 30 days, 6 and 12months was 0%, 1.8% and 1.8%, respectively.
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Conclusion:
Two-thirds of patients undergoing elective peripheral vascular surgery have unsuspected coronary ischemia. FFRCT can help guide multidisciplinary team approach for optimal patient management, including elective coronary revascularization. Favourable early results suggest the need for controlled outcome studies to determine the role of FFRCT in the management of CAD in peripheral vascular patients.
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