5-Year Outcomes According to FFR of Left Circumflex Coronary Artery After Left Main Crossover Stenting
Cheol Hyun Lee1, Sang-Woong Choi1, Jongmin Hwang1
1Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea.
Insights
Fractional flow reserve (FFR) measurement in the jailed left circumflex artery after left main stenting predicts long-term outcomes. A low FFR (≤0.80) indicates higher risk for target lesion failure, guiding treatment decisions.
Area of Science:
- Cardiovascular medicine
- Interventional cardiology
- Medical imaging and diagnostics
Background:
- Provisional side-branch intervention with FFR guidance is validated for non-LM bifurcations.
- The clinical utility of FFR in left main (LM) bifurcation disease remains less understood.
- Assessing jailed side branches after LM stenting is crucial for guiding treatment.
Purpose of the Study:
- To evaluate the long-term clinical impact of fractional flow reserve (FFR) in the jailed left circumflex coronary artery (LCx) after left main coronary artery (LM) simple crossover stenting.
- To determine if FFR measurements can predict target lesion failure (TLF) in this specific patient cohort.
- To assess the correlation between FFR and angiographic stenosis in the jailed LCx.
Main Methods:
- Retrospective analysis of 83 patients undergoing LM-to-left anterior descending coronary artery crossover stenting.
- Post-stenting FFR measurements were performed in the jailed LCx.
- Clinical outcomes, including a 5-year rate of target lesion failure (TLF), were assessed.
- Low FFR was defined as ≤0.80.
Main Results:
- Mean FFR in the LCx was 0.87 ± 0.08; 16.9% of patients had low FFR.
- No correlation was found between FFR and angiographic % diameter stenosis in the jailed LCx.
- The low FFR group showed a significantly higher 5-year TLF rate (33.4% vs. 10.7%) compared to the high FFR group.
- Low FFR was an independent predictor of 5-year TLF (HR: 6.49; p=0.018).
Conclusions:
- Patients with high FFR in the jailed LCx demonstrated better 5-year clinical outcomes.
- FFR measurement in the jailed LCx is valuable for selecting appropriate treatment strategies.
- Utilizing FFR can potentially reduce the need for complex procedures in LM bifurcation stenting.
Objectives:
The aim of the current study was to evaluate the long-term clinical impact of fractional flow reserve (FFR) in jailed left circumflex coronary artery (LCx) after left main coronary artery (LM) simple crossover stenting.
Background:
Although the provisional side-branch intervention with FFR guidance has been validated for non-LM bifurcation lesions, the outcome of such a strategy in LM bifurcation disease is not well-known.
Methods:
Patients who underwent LM-to-left anterior descending coronary artery simple crossover stenting and who had FFR measurements in the LCx thereafter were enrolled. A low FFR was defined as ≤0.80. The clinical outcomes were assessed by the 5-year rate of target lesion failure (TLF) (a composite of cardiac death, target-vessel myocardial infarction, or target lesion revascularization).
Results:
In 83 patients, the mean FFR of the LCx after LM stenting was 0.87 ± 0.08, and 14 patients (16.9%) had a low FFR. There was no correlation between the FFR and angiographic % diameter stenosis in jailed LCx (R2 = 0.039; p = 0.071) and there was no difference in the angiographic % diameter stenosis in the high and low FFR groups. At 5 years, the low FFR group had a significantly higher rate of TLF than the high FFR group (33.4% vs. 10.7%; hazard ratio: 4.09, 95% confidence interval: 1.15 to 14.52; p = 0.029). However, there was no difference in the clinical outcomes according to the angiographic % diameter stenosis. In a multivariate analysis, a low FFR was an independent predictor of the risk for a 5-year TLF (hazard ratio: 6.49; 95% confidence interval: 1.37 to 30.73; p = 0.018).
Conclusions:
The patients with a high FFR in jailed LCx had better 5-year outcomes than those with a low FFR. The FFR measurement in jailed LCx can be helpful in selecting an adequate treatment strategy and may reduce unnecessary complex procedures.
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