Coronary pressure measurement to determine treatment strategy for equivocal left main coronary artery lesions

Abstract

It is often hard to select a treatment strategy for equivocal left main coronary artery (LMCA) disease. We investigated the usefulness of coronary pressure (CP) measurement for determining the treatment strategy in intermediate LMCA disease. We measured CP in 15 consecutive patients with equivocal LMCA disease (age 67.6 +/- 7.5 years, 14 males). Myocardial fractional flow reserve (FFRmyo) was obtained as the ratio of CP distal to the lesion/aortic pressure under maximal coronary dilation. Patients with FFRmyo > or = 0.75 and <0.75 received medical therapy and coronary artery bypass grafting (CABG), respectively, and were followed up for 32.5 +/- 9.7 (20-47) months. Eight patients received medical therapy and 7 patients underwent CABG in accordance with the FFRmyo criteria noted above. FFRmyo of the LMCA was 0.91 +/- 0.01 and 0.61 +/- 0.03 in patients who received medical and surgical therapy, respectively. Neither reference vessel diameter, minimal lumen diameter, nor percent diameter stenosis was significantly different between patients who received medical and surgical therapy. During the follow-up period, no patients with medical therapy showed symptoms due to the LMCA lesion. Similarly, 5 of 7 patients with CABG showed improvement of symptoms and the remaining 2 patients were hospitalized with congestive heart failure. No cardiac death was recorded in the patients with medical or surgical therapy. In conclusion, the present results clearly demonstrated that CP is clinically useful for determining the treatment strategy for equivocal LMCA lesions but coronary angiography is not.

Left Main Coronary Artery Disease

“…Measuring the FFR makes it possible to perform a functional assessment of the ability of a coronary artery stenosis to induce ischemia both at rest and during pharmacological stress. The application of FFR in LMCA lesions has been assessed in small clinical trials, which have all confirmed the results already achieved in other coronary artery segments [89,[96][97][98][99][100]. The application of FFR in LMCA lesions has been assessed in small clinical trials, which have all confirmed the results already achieved in other coronary artery segments [89,[96][97][98][99][100].…”

Long‐term outcomes following fractional flow reserve‐guided treatment of angiographically ambiguous left main coronary artery disease: A meta‐analysis of prospective cohort studies

“…However, this study was not included in our analysis, since half of the patients with FFR <0.75 ( n = 7/14), had protected LMCA stenosis. The study by Suemaru et al involving a total of 15 patients with ambiguous LMCA stenosis who underwent CABG based on FFR cut off value of 0.75, was not included in the final analysis as there were no events (no deaths or myocardial infarctions or revascularizations) in either group during the follow up period. The study by Jimenez Navarro et al was not included in the meta‐analysis of only myocardial infarctions as there were zero infarctions in both the groups.…”

Outcomes Associated With Fractional Flow‐Guided Revascularization: A Meta‐analysis

“…7 -10,17-29 The left main coronary artery disease subgroup included 8 studies, including 357 in the no ischemia/deferral group and 238 in the ischemia/ revascularization group. 7,9,10,19,20,22,23,27 The non-left main coronary artery disease subgroup included 9 studies, including 1299 in the no ischemia/deferral group and 1081 in the ischemia/revascularization group. 17 In the left main subgroup, the mean age in the no ischemia/deferral group was 63 (±3) years and 62 (±5) years in the ischemia/revascularization group, whereas the mean FFR was 0.89 vs 0.68, respectively.…”