ABSTRACT
Background: Fractional flow reserve (FFR) has become the gold standard for diagnosing ischemia in angiographically intermediate epicardial coronary artery stenosis. This study investigated the clinical outcomes and predictors of revascularization deferral based on FFR. Methods: In this retrospective cohort study, we assessed 474 lesions (440 patients) where revascularization was deferred based on the FFR value. Minimum lumen diameter and %-diameter stenosis were measured. Calcification was graded as none, mild, moderate, or heavy. The synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score I was also determined. The primary outcome was ischemia-driven target lesion revascularization (TLR) in deferred lesions within 3 years. Patients were also assigned into two groups based on FFR value. Results: The average age of the patients was 69.7±10.4 years. The average FFR value was 0.86±0.05. Stable angina pectoris was noted in 298 (67.7%) cases, and in-stent restenosis (ISR) was present in 28 (5.9%). The average SYNTAX score was 7.2±4.2. The 3-year ischemia-driven TLR was 18 lesions (3.8%). Cox proportional hazard model revealed that the SYNTAX score and ISR were independent predictors for TLR in deferred lesions [hazard ratio (HR) =1.10, 95% confidential interval (CI): 1.01-1.19, P=0.03; HR =6.33; 95% CI: 2.25-17.8, P<0.01, respectively]. The deferral group, with a low FFR value, tended to have higher TLR rates than other groups. Conclusions: Lesions with lower FFR values were associated with a higher incidence of ischemia-driven TLR than those with higher FFR values. SYNTAX score and ISR were predictors for ischemia-driven TLR at 3 years in the deferred lesions.
ABSTRACT
In addition to barium swallow, the health screening center of our hospital has started meansuring serum pepsinogen (PG) levels in the stomach cancer screening tests since 1998 if patients wish to receive the PG test. During the past five years, 94 gastric cancer cases were detected by both methods. The average detection ratio worked out at 79.8% for the barium method and 71.3% for the PG method. Of the 94 cases, 51.1% tested positive by both methods. The positivity ratio was 28.7% for the barium method alone and 20.2% for the pepsinogen method alone. In other words, it follows that nearly half of the cancer cases have been picked out by either of the two techniques. Therefore, it could be said that the two methods serve as complementary one to the other. Thus, it was confirmed that using the PG method together with the barium method is worthwhile.The hitting ratio of positive reaction was high in patients at level 2 and upward when checked according to PG levels, and in patients whose initial test results were negative and later shifted to level 2 or level 4 with the lapse of time. These findings suggest that it is feasible to presupposed a group of people at higher risk for developing gastric cancer.
Subject(s)
Phosphatidylglycerols , Pepsinogen A , Stomach Neoplasms , Serum , BariumABSTRACT
During the 10-year period from January 1978 to December 1987, our department of surgery performed a total of 1, 839 surgical operations for cancer of the stomach. The surgical removal rate stood at 96.9%, and 80.2% of the patients who underwent surgery were cured. The cases of early grastic cancer accounted for 54.3%. The death rates under and after the operation were 0.3% and 0.8%, respectively.<BR>The 5-year suvival rates for progressive cancer removal cases and cured cases are 53.9% and 74.2%, respectively.<BR>To improve the results of treatment, improvements should be made to the method of physical examination for early detection of diseases and diagnostics, and surgical techniques. In addition, interdepartmental collaboration in therapy is called for.
