Left Main Coronary Artery Compression in Patients With Pulmonary Arterial Hypertension and Angina

• Published in: Journal of the American College of Cardiology 2017-06, Vol.69 (23), p.2808-2817
• Main Authors: Galiè, Nazzareno, MD, Saia, Francesco, MD, Palazzini, Massimiliano, MD, Manes, Alessandra, MD, Russo, Vincenzo, MD, Bacchi Reggiani, Maria Letizia, PhD, Dall’Ara, Gianni, MD, Monti, Enrico, MD, Dardi, Fabio, MD, Albini, Alessandra, MD, Rinaldi, Andrea, MD, Gotti, Enrico, MD, Taglieri, Nevio, MD, Marrozzini, Cinzia, MD, Lovato, Luigi, MD, Zompatori, Maurizio, MD, Marzocchi, Antonio, MD
• Format: Article
• Language: English
• Subjects: Adult; Angina; Angina pectoris; Angina Pectoris - diagnosis; Angina Pectoris - etiology; Angiography; Cardiology; Cardiovascular; Catheters; Compressing; Compression; Compression tests; Computed tomography; computed tomography coronary angiography; Coronary Angiography; Coronary artery; Coronary Stenosis - complications; Coronary Stenosis - diagnosis; Coronary Stenosis - surgery; Coronary vessels; Coronary Vessels - diagnostic imaging; Coronary Vessels - surgery; Death; Effectiveness; Female; Follow-Up Studies; Heart; Heart surgery; Humans; Hypertension; Hypertension, Pulmonary - diagnosis; Hypertension, Pulmonary - etiology; Hypertension, Pulmonary - physiopathology; Internal Medicine; Ischemia; Lung transplantation; Male; Mortality; Pain; Patients; Percutaneous Coronary Intervention - methods; percutaneous coronary interventions; Prospective Studies; Pulmonary arteries; Pulmonary artery; Pulmonary Artery - diagnostic imaging; Pulmonary hypertension; Restenosis; Safety; Screening; Stenosis; Stents; Surgery; Tomography, X-Ray Computed; Xenografts
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2017.03.597

Abstract Background Left main coronary artery (LMCA) compression is increasingly recognized as a cause of angina in pulmonary arterial hypertension (PAH). Objectives This study aimed to evaluate the prevalence of LMCA extrinsic compression from a dilated pulmonary artery (PA) in patients with PAH and angina or angina-like symptoms, determine the usefulness of screening with computed tomography coronary angiography (CTCA), and assess the safety and efficacy of percutaneous coronary interventions (PCIs). Methods All patients with PAH and angina or angina-like symptoms attending the center between May 1, 2008, and December 31, 2013, underwent CTCA. Patients with confirmed LMCA stenosis on selective coronary angiography had PCI. Results Of 765 patients with PAH, 121 had angina or angina-like symptoms. Ninety-four patients had abnormal CTCA based on the relationship between the PA and the LMCA and underwent selective coronary angiography. LMCA stenosis ≥50% was detected in 48 of the 94 patients. Forty-five patients underwent PCI with stenting, of whom 41 had sustained angina symptom relief. The 3 other patients had surgical PA reduction plasty. Nine months after PCI, 5 patients had LMCA restenosis and PCI was successfully repeated. The best predictor of LMCA stenosis ≥50% was a PA diameter ≥40 mm. Rates for death or double-lung transplant and the composite rates for death, double-lung transplant, or restenosis at 36 months were 5% and 30%, respectively. Conclusions The prevalence of LMCA compression in patients with PAH and angina is high. These results suggest that CTCA is indicated in patients with PAH and angina or angina-like symptoms. PCI was well tolerated, improved symptoms, and resulted in favorable long-term outcomes.