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The role of OCT and measuring FFR to improve the efficiency of PCI on patient with left main bifurcation lesions

Session HFA Discoveries - ePosters

Speaker Associate Professor Daniil Maximkin

Event : HFA Discoveries 2020

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease – Treatment
  • Session type : ePosters

Authors : D Maximkin (Moscow,RU), Z Shugushev (Moscow,RU), A Chepurnoy (Moscow,RU), O Safonova (Moscow,RU), A Mambetov (Moscow,RU), A Faibushevich (Moscow,RU), E Gitelzon (Moscow,RU), G Veretnik (Moscow,RU), V Baranovich (Moscow,RU)

Authors:
D Maximkin1 , Z Shugushev1 , A Chepurnoy1 , O Safonova1 , A Mambetov1 , A Faibushevich1 , E Gitelzon1 , G Veretnik1 , V Baranovich1 , 1Peoples Friendship University of Russia (RUDN University) - Moscow - Russian Federation ,

Citation:

AIMS to evaluated the role of intravascular imaging methods (OCT, FFR), in determining the hemodynamic significance stenosis of left main coronary artery (LMCA) bifurcation and their prognostic significance.

METHODS AND RESULTS: 177 patients were selected in the study. Inclusion criteria: true bifurcation stenosis of the LMCA according to quantitative coronary angiography (QCA) and OCT; FFR (LCx or LAD) <0,8, minimal lumen area (MLA) LM <6 mm2 ; total risk according SYNTAX score I <32. After coronary angiography, all patients underwent OCT in LM and measurement of the FFR in LAD and LCx, in order to determine the hemodynamic significance of the lesion. The study included 98 patients, who have hemodynamic significant lesion was confirmed by both methods (OCT and FFR), and there was a complete coincidence. Initially, all patients performed «provisional T» stenting of the LMCA (1stent strategy). After the procedure, a FFR were measured in the side branch of bifurcation (LCx or LAD). Drug-eluting stents were implanted in all patients. At the end of the stenting procedure, all patients underwent OCT for evaluating the optimal stent implantation. The control group Primary endpoints: frequency of MACE (death, myocardial infarction, repeated revascularizations). Secondary endpoints: frequency of restenosis according to Q?A and OCT. The follow-up were 48 months.
Results: of the 197 patients, who initially selected for the study, the data on the hemodynamic significance lesions of LM were coincided in 118 patients, who reached the main cohort of patients. A comparative analysis of the OCT and FFR showed, that in 79 patients a mismatch of data was revealed. At the same time, FFR was positive in 67 (84.8%) patients, negative in 12(15.2%). On the contrary, according to OCT, hemodynamically significant stenosis occurred in 12(15.2%) patients, and in 67 (84.8%) – insignificant (?2 = 39.68 p<0.05). Further, the patients were divided in 2 groups. Group I (n=80) included patients with FFR SB >0.8, and Group II (n=38) - FFR SB<0.8. Patients in group 2 were implanted second stent (reverse-crash and reverse-culotte techniques). The long-term results were monitored in all patients. The freedom from cardiac events (Kaplan-Maier analysis) were not significant difference in both group (100 and 97.4%; p>0.05). The frequency of hemodynamic significant restenosis of and target lesion revascularization (TLR) according to OCT and FFR was observed in 5 patient (6.25%) in group I and in 4 patients (10.5%) in group II (p>0.05).

CONCLUSIONS the FFR measurement of patients with true LMCA bifurcation stenosis before the stenting procedure allows to correctly determining the strategy of stenting, compare the OCT. FFR measurement not only before stenting procedure, but also after, provides a similar long-term outcomes for the primary endpoint, regardless of the stenting strategy.

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