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. 2021 Oct;44(10):1377-1385.
doi: 10.1002/clc.23693. Epub 2021 Jul 16.

Predictors and 3-year outcomes of compromised left circumflex coronary artery after left main crossover stenting

Hameed Ullah  1 , Karim Elakabawi  1   2 , Han Ke  1 , Najeeb Ullah  3 , Habib Ullah  4 , Sardar Ali Shah  1 , Hamad Haider Khan  5 , Muhammad Asad Khan  6 , Ning Guo  1 , Zuyi Yuan  1
Affiliations

Predictors and 3-year outcomes of compromised left circumflex coronary artery after left main crossover stenting

Hameed Ullah et al. Clin Cardiol. 2021 Oct.

Abstract

Background: There are few predictors of decreased fractional flow reserve (FFR) in the left circumflex coronary artery (LCx) after left main (LM) crossover stenting.

Objectives: We aimed to determine the predictors for low FFR at LCx and possible treatment strategies for compromised LCx, together with their long-term outcomes.

Methods: Altogether, 563 patients who met the inclusion criteria were admitted to our hospital from February 2015 to November 2020 with significant distal LM bifurcation lesions. They underwent single-stent crossover percutaneous coronary intervention (PCI) under intravascular ultrasound (IVUS) guidance with further LCx intervention based on the measured FFR.

Results: The patients showed significant angiographic LCx ostial affection post-LM stenting, but only 116 (20.6%) patients had FFR < 0.8. The three-year composite major adverse cardiac events (MACE) rates were comparable between the high and low FFR groups (16.8% vs. 15.5; p = 0.744). In a multivariate analysis, low FFR at the LCx was associated with post-stenting minimal luminal area (MLA) of LCx (odds ratio [OR]: 0.032, p < .001), post-stenting LCx plaque burden (OR: 1.166, p < .001), poststenting LM MLA (OR: 0.821, p = .038), and prestenting LCx MLA (OR: 0.371, p = .044). In the low FFR group, those with compromised LCx managed with drug-eluting balloon had the lowest three-year MACE rate (8.1%), as compared to either those undergoing kissing balloon inflation (KBI) (17.5%) or stenting (20.5%) (p = 0.299).

Conclusion: Unnecessary LCx interventions can be avoided with FFR-guided LCx intervention. Poststenting MLA and plaque burden of the LCx, and main vessel stent length are poststenting predictors of low FFR.

Keywords: compromised left circumflex artery; drug-eluting balloon; fraction flow reserve; intravascular ultrasound; left main stem; percutaneous interventions.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
MACE comparison among the groups in three‐years of follow‐up. Cumulative 3‐year event rate according to FFR in LCx. FFR, fraction flow reserve; LCx, left circumflex; MACE, major adverse cardiovascular events (all cause of mortality, reinfarction, ischemia‐driven target vessel revascularization [TVR], or stent thrombosis); PCI, percutaneous coronary interventions
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