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Published on: January 28, 2020
Predictors and 3-year outcomes of compromised left circumflex coronary artery after left main crossover stenting
Hameed Ullah1, Karim Elakabawi1,2, Han Ke1
1Department of Cardiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Insights
Fractional flow reserve (FFR) guided intervention can help avoid unnecessary procedures in the left circumflex coronary artery (LCx) after left main (LM) stenting. Key predictors of low FFR include post-stenting minimal luminal area and plaque burden in the LCx.
Area of Science:
- Interventional Cardiology
- Cardiovascular Imaging
- Clinical Outcomes Research
Background:
- Predictors for reduced fractional flow reserve (FFR) in the left circumflex coronary artery (LCx) following left main (LM) crossover stenting are not well-established.
- Understanding these predictors is crucial for optimizing treatment strategies and patient outcomes.
Purpose of the Study:
- To identify predictors of low FFR in the LCx post-LM stenting.
- To evaluate treatment strategies for compromised LCx and their long-term outcomes.
Main Methods:
- A cohort of 563 patients with significant distal LM bifurcation lesions underwent single-stent crossover percutaneous coronary intervention (PCI) guided by intravascular ultrasound (IVUS).
- LCx intervention decisions were based on measured FFR.
- Long-term outcomes, including major adverse cardiac events (MACE), were assessed over three years.
Main Results:
- Only 20.6% of patients had an FFR < 0.8 in the LCx despite angiographic evidence of ostial affection.
- Low LCx FFR was significantly associated with post-stenting minimal luminal area (MLA) of LCx, LCx plaque burden, post-stenting LM MLA, and pre-stenting LCx MLA.
- In patients with low FFR, treatment with a drug-eluting balloon resulted in the lowest three-year MACE rate (8.1%) compared to kissing balloon inflation (17.5%) or stenting (20.5%).
Conclusions:
- FFR-guided intervention can prevent unnecessary LCx procedures after LM stenting.
- Post-stenting MLA and plaque burden of the LCx, along with main vessel stent length, are significant predictors of low FFR.
Background:
There are few predictors of decreased fractional flow reserve (FFR) in the left circumflex coronary artery (LCx) after left main (LM) crossover stenting.
Objectives:
We aimed to determine the predictors for low FFR at LCx and possible treatment strategies for compromised LCx, together with their long-term outcomes.
Methods:
Altogether, 563 patients who met the inclusion criteria were admitted to our hospital from February 2015 to November 2020 with significant distal LM bifurcation lesions. They underwent single-stent crossover percutaneous coronary intervention (PCI) under intravascular ultrasound (IVUS) guidance with further LCx intervention based on the measured FFR.
Results:
The patients showed significant angiographic LCx ostial affection post-LM stenting, but only 116 (20.6%) patients had FFR < 0.8. The three-year composite major adverse cardiac events (MACE) rates were comparable between the high and low FFR groups (16.8% vs. 15.5; p = 0.744). In a multivariate analysis, low FFR at the LCx was associated with post-stenting minimal luminal area (MLA) of LCx (odds ratio [OR]: 0.032, p < .001), post-stenting LCx plaque burden (OR: 1.166, p < .001), poststenting LM MLA (OR: 0.821, p = .038), and prestenting LCx MLA (OR: 0.371, p = .044). In the low FFR group, those with compromised LCx managed with drug-eluting balloon had the lowest three-year MACE rate (8.1%), as compared to either those undergoing kissing balloon inflation (KBI) (17.5%) or stenting (20.5%) (p = 0.299).
Conclusion:
Unnecessary LCx interventions can be avoided with FFR-guided LCx intervention. Poststenting MLA and plaque burden of the LCx, and main vessel stent length are poststenting predictors of low FFR.
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