Jaya Mallidi1, Auras R Atreya1, James Cook1, Jane Garb2, Allen Jeremias3, Lloyd W Klein4, Amir Lotfi1. 1. Department of Medicine, Division of Cardiology, Baystate Medical Center, Tufts University, Springfield, Massachusetts. 2. Department of Medicine, Division of Biostatistics, Baystate Medical Center, Tufts University, Springfield, Massachusetts. 3. Department of Medicine, Division of Cardiovascular Medicine, Stony Brook University Medical Center, Stony Brook, New York. 4. Department of Medicine, Division of Cardiology, Advocate Illinois Masonic Medical Center, Rush Medical College, Chicago, Illinois.
Abstract
OBJECTIVE: To define the long term outcomes of Fractional Flow Reserve (FFR) guided revascularization of ambiguous left main coronary artery (LMCA) lesions by performing a pooled meta-analysis of all available studies. BACKGROUND: Prospective studies evaluating the use of fractional flow reserve (FFR) for clinical decision-making in ambiguous unprotected left main coronary artery (LMCA) stenosis suggest the relative safety of that approach, but any final conclusions are limited by small sample size. We performed a pooled meta-analysis of studies to define the long-term outcomes in these patients. METHODS: Six prospective cohort studies involving 525 patients met the inclusion criteria. Patients underwent revascularization (revascularization group) or medical therapy (deferred group) based on FFR. The primary outcome was defined as rate of major cardiovascular events (a composite of death from all causes, nonfatal myocardial infarctions and subsequent revascularizations). The secondary outcomes included individual components of the primary end point. Pooled effect sizes were calculated using a fixed effects model. RESULTS: Based on the FFR results, 217 patients (41%) underwent revascularization. There was no statistically significant difference between the groups in the rates of primary end point (P = 0.15), all-cause mortality (P = 0.06) or nonfatal myocardial infarctions (P = 0.76). However, there was a significant increase in the rate of subsequent revascularizations in the deferred patients (P = 0.002). CONCLUSION: The long term clinical outcomes in patients with ambiguous LMCA stenosis for whom revascularization is deferred based on FFR are favorable and similar to the revascularized group in terms of overall mortality and subsequent myocardial infarctions.
OBJECTIVE: To define the long term outcomes of Fractional Flow Reserve (FFR) guided revascularization of ambiguous left main coronary artery (LMCA) lesions by performing a pooled meta-analysis of all available studies. BACKGROUND: Prospective studies evaluating the use of fractional flow reserve (FFR) for clinical decision-making in ambiguous unprotected left main coronary artery (LMCA) stenosis suggest the relative safety of that approach, but any final conclusions are limited by small sample size. We performed a pooled meta-analysis of studies to define the long-term outcomes in these patients. METHODS: Six prospective cohort studies involving 525 patients met the inclusion criteria. Patients underwent revascularization (revascularization group) or medical therapy (deferred group) based on FFR. The primary outcome was defined as rate of major cardiovascular events (a composite of death from all causes, nonfatal myocardial infarctions and subsequent revascularizations). The secondary outcomes included individual components of the primary end point. Pooled effect sizes were calculated using a fixed effects model. RESULTS: Based on the FFR results, 217 patients (41%) underwent revascularization. There was no statistically significant difference between the groups in the rates of primary end point (P = 0.15), all-cause mortality (P = 0.06) or nonfatal myocardial infarctions (P = 0.76). However, there was a significant increase in the rate of subsequent revascularizations in the deferred patients (P = 0.002). CONCLUSION: The long term clinical outcomes in patients with ambiguous LMCA stenosis for whom revascularization is deferred based on FFR are favorable and similar to the revascularized group in terms of overall mortality and subsequent myocardial infarctions.
Authors: Michael Michail; Udit Thakur; Ojas Mehta; John M Ramzy; Andrea Comella; Abdul Rahman Ihdayhid; James D Cameron; Stephen J Nicholls; Stephen P Hoole; Adam J Brown Journal: Open Heart Date: 2020-10
Authors: Katharina A Riedl; Jesper M Jensen; Brian S Ko; Jonathon Leipsic; Erik L Grove; Ole N Mathiassen; Hans Erik Bøtker; Bjarne L Nørgaard Journal: Int J Cardiovasc Imaging Date: 2021-08-12 Impact factor: 2.357