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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 Krievins1, Gustavs Latkovskis1, Edgars Zellans1, Roberts Rumba1, Karlis Kaufmanis2, Sanda Jegere1, Andrejs Erglis1
Pauls Stradins Clinical University Hospital, Latvia1, Pauls Stradins clinical university hospital, Latvia2
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. 
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 0.80distal to stenosis in>2mm vessel. Primary endpoint was MACE (cardiac death, MI, urgent revascularization) at 30 days, 6and 12 months.
Results:
Pre-op FFRCT was performed in114 consecutive patients (age 668 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.
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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