Author + information
- Received January 3, 2019
- Revision received February 19, 2019
- Accepted February 22, 2019
- Published online May 6, 2019.
- Cheol Hyun Lee, MDa,
- Sang-Woong Choi, MDa,
- Jongmin Hwang, MDa,
- In-Cheol Kim, MDa,
- Yun-Kyeong Cho, MDa,
- Hyoung-Seob Park, MDa,
- Hyuck-Jun Yoon, MDa,
- Hyungseop Kim, MDa,
- Seongwook Han, MDa,
- Jin Young Kim, MDb,
- Joo Myung Lee, MDc,
- Joon-Hyung Doh, MDd,
- Eun-Seok Shin, MDe,
- Bon-Kwon Koo, MDf,
- Seung-Ho Hur, MDa and
- Chang-Wook Nam, MDa,∗ ()
- aDivision of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea
- bDepartment of Radiology, Keimyung University Dongsan Hospital, Daegu, South Korea
- cDivision of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- dDepartment of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea
- eDepartment of Cardiology, Ulsan Hospital, Ulsan, South Korea
- fDepartment of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
- ↵∗Address for correspondence:
Prof. Chang-Wook Nam, Department of Internal Medicine, College of Medicine, Keimyung University Dongsan Hospital, 94, Jung-gu, Dongsan-dong, Daegu 700-712, Korea.
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.
- clinical outcomes
- fractional flow reserve
- left main coronary artery disease
- percutaneous coronary intervention
Dr. Joo Myung Lee has received a research grant from St. Jude Medical (Abbott Vascular) and Philips Volcano. Dr. Bon-Kwon Koo has received an institutional research grant from St. Jude Medical (Abbott Vascular) and Philips Volcano. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 3, 2019.
- Revision received February 19, 2019.
- Accepted February 22, 2019.
- 2019 American College of Cardiology Foundation
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