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The importance of measuring fractional flow reserve to improve the efficiency of endovascular treatment on left main bifurcation lesions

Session Comorbidities and cardiomyopathies - How to manage?

Speaker Associate Professor Daniil Maximkin

Event : Heart Failure 2018

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Chronic Ischemia
  • Session type : Rapid Fire Abstracts

Authors : D A Maximkin (Moscow,RU), Z KH Shugushev (Moscow,RU), AG Chepurnoy (Moscow,RU), OO Safonova (Moscow,RU), AG Faibushevich (Moscow,RU)

D A Maximkin1 , Z KH Shugushev1 , AG Chepurnoy1 , OO Safonova1 , AG Faibushevich1 , 1Peoples Friendship University of Russia (RPFU) - Moscow - Russian Federation ,

Chronic Ischemia

Aim: to increase the effectiveness of endovascular treatment in patients with LM bifurcation lesions.

Methods: 157 patients were enrolled in the study. Inclusion criteria: true bifurcation stenosis of the LMCA according to QSA and IVUS; total risk according SYNTAX score <32. All patients initially performed «Provisional T» stenting of the LMCA (1stent strategy). After the procedure, a fractional flow reserve (FFR) was measured in the side branch of bifurcation (LCx or LAD)/ The main cohort of patients (n=88) were divided into 2 groups. Group I (n=44) included patients with FFR SB «+», and group II (n=44) - FFR SB «-». In the Ist group, after FFR measurement, all patients underwent complete bifurcational stenting (revers-crush, revers-culott), and in group II, implantation of the 2d stent was not performed. In retrospectively, the third (III) control group was formed (n=69), where the «Provisional T» stenting of the LMCA was performed without a control FFR measurement. Drug-eluting stents were implanted in all patients. At the end of the stenting procedure, all patients underwent IVUS for evaluating the optimal stent implantation. Long-term results after 48 months were followed in all patients. Primary endpoints: frequency of MACE (death, MI, repeated interventions). (death, MI, revascularizations). Secondary endpoints: frequency of restenosis and late stent thrombosis according to QSA and IVUS.

Results: survival of patients from Group I and II in the long-term period was 100%, and in the third group - 97.1% (p>0.05). Nonfatal MI was observed in 2 patients (2.9%) from group III (p<0.05), in the Ist and IId group of cases MI was not recorded. The frequency of restenosis of and target lesion revascularization (TLR) according to QSA and IVUS was observed in 1 patient (2.3%) in group I and in 5 patients (7.2%) in group III (p <0.05). Frequency of the target vessel revascularization (TVR) occurred in I and II group in 2.3% of patients, and in group III - in 2.9% (p>0.05). The total frequency of MACE in groups I, II and III was 4.5; 2.3 and 15.4%, respectively (p <0.05).

Conclusion: measurement of FFR in the lateral branch of the left main bifurcation after performed PTS significantly improves the prognosis of patients with lesions of the LCA trunk and improves the efficacy and safety of PCI.

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