Clinical outcome in patients with intermediate or equivocal left main coronary artery disease after deferral of surgical revascularization on the basis of fractional flow reserve measurements

How good are experienced interventional cardiologists at predicting the functional significance of intermediate or equivocal left main coronary artery stenoses?

“…It therefore is an accepted indication for surgical revascularisation [13][14][15][16]. On the contrary, functionally not relevant left main disease is associated with excellent survival and low event rates when surgery is deferred and patients are treated medically or by PCI elsewhere in the coronary tree [17][18][19][20]. Before diagnostic angiography is performed guideline conformal conclusive proof of ischemia frequently is not present [8,21].…”

“…The equivalence of a cutoff of 0.75 for the hemodynamic evaluation of left main stem lesions with respect to symptomatic and prognostic relevance has been shown by several studies [18][19][20], however, there has been no randomized prospective trial for this patient group yet. The cutoff of 0.75 for the determination of inducible ischemia by FFR has only been validated for single-vessel disease with normal left ventricular function, without left ventricular hypertrophy or diabetes mellitus [25].…”

“…The results of our study suggest that this conclusion applies in particular to patients with moderate or equivocal LMCA stenoses. We could show in this same population of 51 patients that deferral of surgery based on an FFR measurement result of greater or equal to 0.75 is associated with excellent long-term survival and low event rates [20].…”

Fractional flow reserve-guided myocardial revascularization

“…Małą przydatność angiografii w ocenie istotności klinicznej angiograficznie niejednoznacznych zwężeń pnia lewej tętnicy wieńcowej udokumentowano w kilku badaniach klinicznych z zastosowaniem FFR i/lub IVUS [16][17][18][19][20][21][22]. We wszystkich tych badaniach średni stopień zwężenia w QCA był niemal identyczny w grupach pacjentów z istotnym zwężeniem (FFR ≤ 0,75-0,80 lub LAmin w IVUS < 6,0 mm 2 ) lub nieistotnym zwężeniem (FFR > 0,75-0,80 lub LAmin w IVUS > 6,0 mm 2 ) i wynosił około 45%.…”

Quantification of I-123-meta-iodobenzylguanidine Heart-to-Mediastinum Ratios: Not So Simple After All

“…For example, the use of a single binary threshold of fractional flow reserve in decision of treatment for coronary artery disease has also been questioned. 30 …”