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Tytuł:
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Effect of permanent right internal mammary artery occlusion on right coronary artery supply: A randomized placebo-controlled clinical trial.
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Autorzy:
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Bigler MR; Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland.
Stoller M; Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland.
Tschannen C; Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland.
Grossenbacher R; Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland.
Seiler C; Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland. Electronic address: .
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Źródło:
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American heart journal [Am Heart J] 2020 Dec; Vol. 230, pp. 1-12. Date of Electronic Publication: 2020 Sep 17.
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Typ publikacji:
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Journal Article; Randomized Controlled Trial
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Język:
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English
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Imprint Name(s):
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Original Publication: St. Louis, MO : Mosby
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MeSH Terms:
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Collateral Circulation*
Mammary Arteries*/diagnostic imaging
Balloon Occlusion/*methods
Coronary Artery Disease/*therapy
Coronary Vessels/*physiology
Myocardial Ischemia/*diagnosis
Aged ; Angina Pectoris/physiopathology ; Angina Pectoris/therapy ; Blood Pressure ; Cardiac Catheterization/methods ; Chronic Disease ; Coronary Angiography ; Coronary Artery Disease/diagnostic imaging ; Coronary Artery Disease/physiopathology ; Coronary Circulation ; Double-Blind Method ; Electrocardiography ; Equivalence Trials as Topic ; Female ; Humans ; Male ; Myocardial Ischemia/physiopathology ; Placebos/therapeutic use ; Prospective Studies
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Molecular Sequence:
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ClinicalTrials.gov NCT03950947
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Substance Nomenclature:
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0 (Placebos)
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Entry Date(s):
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Date Created: 20200919 Date Completed: 20201231 Latest Revision: 20210817
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Update Code:
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20240104
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DOI:
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10.1016/j.ahj.2020.09.006
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PMID:
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32949505
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Natural, nonsurgical internal mammary artery (IMA) bypasses to the coronary circulation have been shown to function as extracardiac sources of myocardial blood supply. The goal of this randomized, placebo-controlled, double-blind trial was to test the efficacy of permanent right IMA (RIMA) device occlusion on right coronary artery (RCA) occlusive blood supply and on clinical and electrocardiographic (ECG) signs of myocardial ischemia.
Methods: This was a prospective superiority trial in 100 patients with chronic coronary artery disease randomly allocated (1:1) to RIMA vascular device occlusion (verum group) or to RIMA sham procedure (placebo group). The primary study end point was RCA collateral flow index (CFI) as obtained during a 1-minute ostial RCA balloon occlusion at baseline before and at follow-up examination 6 weeks after the trial intervention. CFI is the ratio between simultaneous mean coronary occlusive divided by mean aortic pressure both subtracted by central venous pressure. Simultaneously obtained secondary study end points were the registration of angina pectoris and quantitative intracoronary ECG ST-segment shift.
Results: CFI change during the follow-up period was +0.036 ± 0.068 in the verum group and -0.021 ± 0.097 in the placebo group (P = .0011). Angina pectoris during the same RCA balloon occlusions had disappeared at follow-up in 14/49 patients of the verum group and in 4/49 patients of the placebo group (P = .0091). Simultaneous intracoronary ECG ST-segment shift change revealed diminished myocardial ischemia at follow-up in the verum group and more severe ischemia in the placebo group.
Conclusions: Permanent RIMA device occlusion augments RCA supply to the effect of diminishing clinical and electrocardiographic signs of myocardial ischemia during a brief controlled coronary occlusion.
(Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)
Comment in: Am Heart J. 2021 Jun;236:100-101. (PMID: 33902817)
