5-Year Outcomes According to FFR of Left Circumflex Coronary Artery After Left Main Crossover Stenting

• Published in: JACC. Cardiovascular interventions 2019-05, Vol.12 (9), p.847-855
• Main Authors: Lee, Cheol Hyun, Choi, Sang-Woong, Hwang, Jongmin, Kim, In-Cheol, Cho, Yun-Kyeong, Park, Hyoung-Seob, Yoon, Hyuck-Jun, Kim, Hyungseop, Han, Seongwook, Kim, Jin Young, Lee, Joo Myung, Doh, Joon-Hyung, Shin, Eun-Seok, Koo, Bon-Kwon, Hur, Seung-Ho, Nam, Chang-Wook
• Format: Article
• Language: English
• Subjects: clinical outcomes; fractional flow reserve; left main coronary artery disease; percutaneous coronary intervention
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2019.02.037

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. 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. 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). 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). 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. [Display omitted]