Introduction:
We assesed the value, in terms of long-term clinical outcome, of a fractional flow reserve (FFR)-guided treatment strategy in patients with angiographically ‘intermediate’ left main coronary artery (LMCA) stenoses.
Methods:
In 215 consecutive patients with an angiographically ‘intermediate’ unprotected LMCA stenosis (between 30–70%, by visual estimate), FFR measurements and off line quantitative coronary angiography (QCA) were obtained. When FFR was ≥0.80, patients were treated medically (medical group); When FFR was <0.80 coronary artery bypass grafting (CABG) was advocated (surgical group). Incidence of death, myocardial infarction and any coronary revascularisation procedure were recorded.
Results:
140 patients had an FFR≥0.80 and 75 patients had an FFR<0.80. Percent diameter stenosis at QCA correlated significantly with FFR (r = −0.38, p<0.001), but a very large scatter was observed (Figure 1B
). Mean follow up duration was 35 ± 25 months. The incidence of death was 7.9 % in the medical group and 9.3 % in the surgical group. (Figure 1A
, p=0.73).
Conclusions
: Angiography alone does not allow appropriate decision making in patients with angiographically ‘intermediate’ stenosis of the LMCA. Given the favorable outcome of an FFR-guided strategy such patients deserve FFR assessment before blindly proceeding to revascularisation.
Figure 1:
A
Kaplan-Meier mortality curves for the 2 study groups.
B
Scatterplots showing the distribution of % diameter stenosis and the corresponding FFR values (filled dots indicate FFR≥0.80 and circles indicate FFR<0.80).
Strategies of Handling a Stenotic Unprotected Left Main Coronary Artery by Multi-Artery Fractional Flow Reserve Method
