5-Year Outcomes According to FFR of Left Circumflex Coronary Artery After Left Main Crossover Stenting |
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Authors: | Cheol Hyun Lee Sang-Woong Choi Jongmin Hwang In-Cheol Kim Yun-Kyeong Cho Hyoung-Seob Park Hyuck-Jun Yoon Hyungseop Kim Seongwook Han Jin Young Kim Joo Myung Lee Joon-Hyung Doh Eun-Seok Shin Bon-Kwon Koo Seung-Ho Hur Chang-Wook Nam |
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Institution: | 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 |
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Abstract: | ObjectivesThe 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.BackgroundAlthough 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.MethodsPatients 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).ResultsIn 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).ConclusionsThe 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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Keywords: | clinical outcomes fractional flow reserve left main coronary artery disease percutaneous coronary intervention CI confidence interval DS diameter stenosis FFR fractional flow reserve HR hazard ratio LAD left anterior descending coronary artery LCx left circumflex coronary artery LM left main coronary artery MI myocardial infarction PCI percutaneous coronary intervention POT proximal optimizing technique PS post-stent QCA quantitative coronary analysis SB side branch(es) TLF target lesion failure TLR target lesion repeat revascularization |
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