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JACC Cardiovasc Interv. 2019 May 13;12(9):847-855. doi: 10.1016/j.jcin.2019.02.037.

5-Year Outcomes According to FFR of Left Circumflex Coronary Artery After Left Main Crossover Stenting.

Author information

1
Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea.
2
Department of Radiology, Keimyung University Dongsan Hospital, Daegu, South Korea.
3
Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
4
Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea.
5
Department of Cardiology, Ulsan Hospital, Ulsan, South Korea.
6
Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea.
7
Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea. Electronic address: ncwcv@dsmc.or.kr.

Abstract

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.

KEYWORDS:

clinical outcomes; fractional flow reserve; left main coronary artery disease; percutaneous coronary intervention

PMID:
31072505
DOI:
10.1016/j.jcin.2019.02.037

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