Background:

Though a wide degree of divergence is exhibited by the functional significance, predictors, and luminal changes of compromised side-branch ostium after the main vessel (MV) stenting, the treatment of choice for left main (LM) bifurcation lesions is preferably the single-stent approach. After LM to left anterior descending (LAD) artery stenting, a compromised LCx may be due to carina shift or plaque. To improve the clinical outcomes, fractional flow reserve (FFR)-guided LCx interventions have been proposed. 

Aim:

The possible treatment strategies for compromised LCx were intended to be established by the study. The predictors for low FFR at LCx were also aimed to be determined.

Methods:

Between February 2015 and November 2020, a retrospective, single-center study was organized at the Department of Cardiology, First Affiliated Hospital of Xian Jiaotong University, PR China. The study included 563 patients whose angiographic diameter stenosis (DS > 50%) after MV stenting indicated a possibly significant or significant ostial LCx lesion. Interventions were considered in 116 (20.6%) patients with FFR < 0.8. According to the operator's preference, three interventional techniques were used:

  • Conversion to the two-stent technique

  • Drug-eluting balloon (DEB)

  • Kissing balloon inflation (KBI)

Major adverse cardiac events (MACE), comprising stent thrombosis, revascularizations, MI, cardiac and non-cardiac deaths, were noted among the patients for a mean of 32.2 ± 8.9 months.

Results:

FFR < 0.8 was observed post-LM stenting in only 116 (20.6%) patients.

Between the high (16.8%) and low (15.5% p = 0.744) FFR groups, composite MACE rates were comparable at three years.

Multivariate analysis of low FFR at the LCx:

  • Post-stenting LCx plaque burden Odds ratio (OR) 1.166, p < .001

  • Post-stenting minimal luminal area (MLA) of LCx OR: 0.032, p < .001

  • Pre-stenting LCx MLA OR: 0.371, p = .044

  • Post-stenting LM MLA OR: 0.821, p = .038

Three-year MACE rates in the low-FFR group:

  • Stenting: 20.5%

  • KBI: 17.5%

  • DEB: 8.1%

The lowest three-year MACE rate was noted in deb managed compromised LCx patients.

Conclusion:

FFR-guided LCx intervention can aid in preventing LCx interventions which are unnecessary. IVUS guided predictors of low FFR post-stenting are plaque burden of the LCx, post-stenting MLA, and main vessel stent length.

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Keywords

Disease Condition,Therapeutic Modality,Coronary Artery Disease,Interventional Cardiology,DCAD_others,Percutaneous Coronary Intervention

Source

https://onlinelibrary.wiley.com/doi/full/10.1002/clc.23693