caa a22 4500 475791606 CHVBK 20180406123712.0 cr unu---uuuuu 170329e20000801xx s 000 0 eng 10.1023/A:1026576223669 doi (NATIONALLICENCE)springer-10.1023/A:1026576223669 Evaluation of the long-term functional outcome assessed by myocardial perfusion scintigraphy following excimer laser angioplasty compared to balloon angioplasty in longer coronary lesions [Elektronische Daten] [Yolande Appelman, Jan Piek, Ernst van der Wall, William Redekop, Eric van Royen, Paolo Fioretti, Pim de Feyter, Jacques Koolen, Sipke Strikwerda, Patrick Serruys, George David, Jan Tijssen, Kong Lie] Objectives: Evaluation of the long-term functional outcome assessed by exercise myocardial perfusion imaging following excimer laser angioplasty compared to balloon angioplasty in coronary lesions >10 mm in length. Background: Previous randomized studies evaluating the effect of coronary interventions mainly focused on the long-term clinical and angiographic outcome. The functional outcome, assessed by myocardial perfusion scintigraphy, has not been evaluated in a randomized setting. Methods: A total of 308 patients with stable angina and a longer coronary lesion (>10 mm) were randomized to excimer laser angioplasty or balloon angioplasty. A 99mTechnetium-2-methoxy isobutyl isonitrile (MIBI) single-photon emission computed tomography (SPECT) study was performed in 139 patients before the initial angioplasty procedure and at 6 months follow-up (73 patients in the laser group versus 66 patients in the balloon group, respectively). Exercise tolerance at follow-up was compared to baseline values by means of exercise duration and double product at peak exercise. Myocardial perfusion of the randomized vascular bed was assessed semi-quantitatively on the MIBI SPECT images. The reversible defects were graded as mild, moderate or severe. Myocardial perfusion at follow-up was expressed as a percentage reduction in incidence and grading of the reversible defects compared to baseline values. Results: Forty-four (61%) patients assigned to laser angioplasty were asymptomatic at 6 months follow-up compared to 34 (52%) patients assigned to balloon angioplasty (p = NS). Improvement in exercise duration and double product were 0.7 ± 2.1 min and 4.3 ± 6.2 min/mmHg/1000, respectively, in the laser group, versus 0.3 ± 2.5 min and 3.1 ± 5.5 min/mmHg/1000, respectively, in the balloon group (both p = NS). The percentage reduction of reversible defects was 23% in patients assigned to laser angioplasty vs. 29% in patients assigned to balloon angioplasty (Relative risk [RR]: 0.79, 95% confidence interval [CI]: 0.40-1.57; p = 0.50). The mild, moderate and severe reversible defects improved in 44.4, 63.6 and 66.6%, respectively, in the laser angioplasty group vs. 66.6, 53.8 and 90%, respectively, in the balloon angioplasty group. None of the comparisons were significantly different. Conclusion: Excimer laser angioplasty compared to balloon angioplasty in coronary lesions >10 mm in length yields a similar long-term functional outcome assessed by anginal status, exercise tolerance and myocardial perfusion. Kluwer Academic Publishers, 2000 balloon angioplasty nationallicence coronary artery disease nationallicence laser angioplasty nationallicence laser-assisted balloon angioplasty nationallicence percutaneous transluminal laser angioplasty nationallicence randomized trial nationallicence myocardial perfusion scintigraphy nationallicence Appelman Yolande Departments of Cardiology, Clinical Epidemiology and Biostatistics, Nuclear Medicine, Academic Medical Center, Amsterdam aut Piek Jan Departments of Cardiology, Clinical Epidemiology and Biostatistics, Nuclear Medicine, Academic Medical Center, Amsterdam aut van der Wall Ernst Department of Cardiology, Leiden University Medical Centre, Netherlands aut Redekop William Departments of Cardiology, Clinical Epidemiology and Biostatistics, Nuclear Medicine, Academic Medical Center, Amsterdam aut van Royen Eric Departments of Cardiology, Clinical Epidemiology and Biostatistics, Nuclear Medicine, Academic Medical Center, Amsterdam aut Fioretti Paolo Thoraxcenter, Dijkzigt Hospital, Rotterdam aut de Feyter Pim Thoraxcenter, Dijkzigt Hospital, Rotterdam aut Koolen Jacques Department of Cardiology, Catharina Hospital, Eindhoven aut Strikwerda Sipke Department of Cardiology, Hospital De Baronie, Breda, The Netherlands aut Serruys Patrick Thoraxcenter, Dijkzigt Hospital, Rotterdam aut David George Departments of Cardiology, Clinical Epidemiology and Biostatistics, Nuclear Medicine, Academic Medical Center, Amsterdam aut Tijssen Jan Departments of Cardiology, Clinical Epidemiology and Biostatistics, Nuclear Medicine, Academic Medical Center, Amsterdam aut Lie Kong Departments of Cardiology, Clinical Epidemiology and Biostatistics, Nuclear Medicine, Academic Medical Center, Amsterdam aut The International Journal of Cardiac Imaging Kluwer Academic Publishers 16/4(2000-08-01), 267-277 0167-9899 16:4<267 2000 16 10554 https://doi.org/10.1023/A:1026576223669 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1023/A:1026576223669 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Appelman Yolande Departments of Cardiology, Clinical Epidemiology and Biostatistics, Nuclear Medicine, Academic Medical Center, Amsterdam aut NATIONALLICENCE 700 1- Piek Jan Departments of Cardiology, Clinical Epidemiology and Biostatistics, Nuclear Medicine, Academic Medical Center, Amsterdam aut NATIONALLICENCE 700 1- van der Wall Ernst Department of Cardiology, Leiden University Medical Centre, Netherlands aut NATIONALLICENCE 700 1- Redekop William Departments of Cardiology, Clinical Epidemiology and Biostatistics, Nuclear Medicine, Academic Medical Center, Amsterdam aut NATIONALLICENCE 700 1- van Royen Eric Departments of Cardiology, Clinical Epidemiology and Biostatistics, Nuclear Medicine, Academic Medical Center, Amsterdam aut NATIONALLICENCE 700 1- Fioretti Paolo Thoraxcenter, Dijkzigt Hospital, Rotterdam aut NATIONALLICENCE 700 1- de Feyter Pim Thoraxcenter, Dijkzigt Hospital, Rotterdam aut NATIONALLICENCE 700 1- Koolen Jacques Department of Cardiology, Catharina Hospital, Eindhoven aut NATIONALLICENCE 700 1- Strikwerda Sipke Department of Cardiology, Hospital De Baronie, Breda, The Netherlands aut NATIONALLICENCE 700 1- Serruys Patrick Thoraxcenter, Dijkzigt Hospital, Rotterdam aut NATIONALLICENCE 700 1- David George Departments of Cardiology, Clinical Epidemiology and Biostatistics, Nuclear Medicine, Academic Medical Center, Amsterdam aut NATIONALLICENCE 700 1- Tijssen Jan Departments of Cardiology, Clinical Epidemiology and Biostatistics, Nuclear Medicine, Academic Medical Center, Amsterdam aut NATIONALLICENCE 700 1- Lie Kong Departments of Cardiology, Clinical Epidemiology and Biostatistics, Nuclear Medicine, Academic Medical Center, Amsterdam aut NATIONALLICENCE 773 0- The International Journal of Cardiac Imaging Kluwer Academic Publishers 16/4(2000-08-01), 267-277 0167-9899 16:4<267 2000 16 10554 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer