scholarly journals Physiology-Based Revascularization of Left Main Coronary Artery Disease

2021 ◽  
Vol 2021 ◽  
pp. 1-16
Author(s):  
Peter Kayaert ◽  
Mathieu Coeman ◽  
Sofie Gevaert ◽  
Michel De Pauw ◽  
Steven Haine
Keyword(s):  
Coronary Artery Disease ◽  
Left Main Coronary Artery ◽  
Critical Importance ◽  
Left Main ◽  
Fractional Flow ◽  
Left Main Disease ◽  
Flow Reserve ◽  
Main Coronary Artery Disease ◽  
Physiological Assessment ◽  
Artery Disease

It is of critical importance to correctly assess the significance of a left main lesion. Underestimation of significance beholds the risk of inappropriate deferral of revascularization, whereas overestimation may trigger major but unnecessary interventions. This article addresses the invasive physiological assessment of left main disease and its role in deciding upon revascularization. It mainly focuses on the available evidence for fractional flow reserve and instantaneous wave-free ratio, their interpretation, and limitations. We also discuss alternative invasive physiological indices and imaging, as well as the link between physiology, ischemia, and prognosis.

scholarly journals Lesion left main coronary artery and / or multivessel coronary artery disease

2021 ◽  
pp. 28-32
Author(s):  
V. A. Skybchyk ◽  
Y. P. Melen
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Invasive Coronary Angiography ◽  
Myocardial Revascularization ◽  
Clinical Signs ◽  
Left Main ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Artery Disease

The article describes the clinical and electrocardiograph|y features of the lesion left main coronary artery (LMCA). LMCA stenosis of more than 50% allows to classificated such patients as a high risk of sudden death, which occurs 3-4 times more often compared with coronary artery disease in other localizations. Another feature characteristic of this category of patients is the presence of multifocal atherosclerosis (MFA). In patients without carotid stenosis, LMCA lesions are detected in 5% of cases, while in patients with MFA (with lesions of the carotid arteries) - in 40%. Despite some clinical signs that allow the patient to suspect the presence of LMCA, the most informative and reliable method is invasive coronary angiography (CAG). Evaluation of CAG using fractional flow reserve (FFR) and intravascular ultrasound (IVUS) help to improve the diagnosis of the degree of LMCA stenosis, assess the nature of the plaque, the true diameter of the vessel and is an important step towards early myocardial revascularization. The article also presents the clinical analysis of lectrocardiogram with lesions of LMCA and multivessel lesions of the coronary arteries (three vessels or more).

Physiological assessment of left main coronary artery disease

2017 ◽  
Vol 13 (7) ◽  
pp. 820-827 ◽  
Author(s):  
Bhavik Modi ◽  
Tim van de Hoef ◽  
Jan Piek ◽  
Divaka Perera
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Left Main ◽  
Main Coronary Artery Disease ◽  
Physiological Assessment ◽  
Artery Disease

scholarly journals Ten-year all-cause death after percutaneous or surgical revascularization for men and women with multivessel or left main coronary artery disease: insights from the SYNTAX extended survival study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Hara ◽  
K Takahashi ◽  
D Klaveren ◽  
M Ono ◽  
H Kawashima ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Mortality Rates ◽  
Public Institution ◽  
Funding Source ◽  
Left Main ◽  
Main Coronary Artery Disease ◽  
Artery Disease ◽  
Extended Survival

Abstract Background In patients with complex coronary artery disease (CAD), women favored coronary artery bypass grafting surgery (CABG) compared to percutaneous coronary intervention (PCI) at 5 years in the SYNTAX trial, whereas mortality rates after PCI and CABG were not different in men. On the other hand, poor outcomes of women undergoing PCI were not observed in the PRECOMBAT and BEST trials. The long-term optimal revascularization strategy according to gender has not been fully evaluated. Purpose In the SYNTAX Extended Survival (SYNTAXES) study, no significant difference existed in all-cause death between PCI and CABG at 10 years. This study aimed to assess treatment effect of PCI and CABG for 10-year all-cause death according to gender. Methods The SYNTAXES study evaluated vital status up to 10 years in 1,800 patients with de novo three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD) randomized to treatment with CABG or PCI in the SYNTAX trial, and the pre-specified primary endpoint was all-cause death at 10 years. In this prespecified analysis, all-cause death at 10 years according to gender in patients undergoing PCI or CABG was evaluated. Results Of 1800 patients, 402 (22.3%) were women and 1398 (77.7%) were men. In women, the rate of mortality was significantly higher in the PCI arm at 5 years than in the CABG arm (19.3% vs. 10.3%; Log-rank p=0.010, Figure A), but the rates of mortality were not different at 10 years between the PCI and CABG arms (33.0% vs. 32.5%; Log-rank p=0.600, Figure A). In men, the mortality rate tended to be higher in the PCI arm at 10 years than in the CABG arm (27.0% vs. 22.5%; Log-rank p=0.082, Figure B), although the mortality rates were not different at 5 years between the PCI and CABG arms (12.4% vs. 12.3%; Log-rank p=0.957, Figure B). Conclusion The efficacy of CABG observed at 5 years disappeared at 10 years in women, whereas the efficacy of CABG became apparent after 5 years in men. Figure 1 Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Erasmus University Medical Centre, Rotterdam, Netherlands, reference: MEC-2016-716

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