Choice and Selection of Treatment Modalities for Cardiac Patients: An Interventional Cardiology Perspective

Agarwal, Shikhar; Tuzcu, E. Murat; Kapadia, Samir

doi:10.1161/jaha.115.002353

Cited by 5 publications

(1 citation statement)

References 61 publications

(105 reference statements)

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“…Despite considerable improvements in percutaneous coronary intervention (PCI) techniques and pharmacotherapeutics, distal left main (LM) coronary artery lesions continue to be one of the most difficult interventional cardiology objectives. 1 The single-stent strategy is superior to the two-stent approach, and is regarded as the treatment of choice whenever feasible for LM bifurcation lesions, 2 even though the predictors, functional significance, and luminal changes for compromised side-branch ostium after main vessel (MV) stenting have a large degree of divergence. 3 Previous studies have indicated that plaque or carina shift are the two main mechanisms for compromised left circumflex coronary artery (LCx) after LM to left anterior descending (LAD) artery stenting.…”

Section: Introductionmentioning

confidence: 99%

Predictors and 3‐year outcomes of compromised left circumflex coronary artery after left main crossover stenting

Ullah

Elakabawi

Han

et al. 2021

Clinical Cardiology

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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 drugeluting 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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Section: Introductionmentioning

confidence: 99%