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

Abstract

OBJECTIVES\nThe 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.\n\n\nBACKGROUND\nAlthough 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.\n\n\nMETHODS\nPatients 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\xa0≤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).\n\n\nRESULTS\nIn 83 patients, the mean FFR of the LCx after LM stenting was 0.87 ± 0.08, and 14 patients (16.9%) had a low\xa0FFR. There was no correlation between the FFR and angiographic % diameter stenosis in jailed LCx (R2\xa0= 0.039; p\xa0=\xa00.071) and there was no difference in the angiographic % diameter stenosis in the high and low FFR groups. At\xa05\xa0years, 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\xa0= 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\xa0= 0.018).\n\n\nCONCLUSIONS\nThe patients with a high FFR in jailed LCx had better 5-year outcomes than those with a low FFR. The\xa0FFR measurement in jailed LCx can be helpful in selecting an adequate treatment strategy and may reduce unnecessary complex procedures.