Open Access

Left main bifurcation stenting: impact of residual ischaemia on cardiovascular mortality

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Date: 16 May 2023
Journal: European Heart Journal , Volume 44 , Issue 41 , Pages 4324 - 4336
Topic: Interventional Cardiology
Authors: H. Wang , R. Zhang , K. Dou , Y. Huang , L. Xie , Z. Qiao , T. Zou , C. Guan , L. Song , W. Yang , Y. Wu , S. Tu , W. Wijns , B. Xu

ESC Journals

AbstractAims

The present study sought to determine the rate and prognostic implications of post-procedural physiologically significant residual ischemia according to Murray law-based quantitative flow ratio (μQFR) after left main (LM) bifurcation percutaneous coronary intervention (PCI).

Methods and results

Consecutive patients undergoing LM bifurcation stenting at a large tertiary care center between January 2014 and December 2016 with available post-PCI μQFR were included. Physiologically significant residual ischemia was defined by post-PCI μQFR values ≤0.80 in the left anterior descending (LAD) or left circumflex artery (LCX). The primary outcome was 3-year cardiovascular death. The major secondary outcome was 3-year bifurcation-oriented composite endpoint (BOCE). Among 1170 included patients with analyzable post-PCI μQFR, 155 (13.2%) had residual ischemia in either LAD or LCX. Patients with vs. those without residual ischemia had a higher risk of 3-year cardiovascular mortality [5.4% vs. 1.3%; adjusted hazard ratio (HR) 3.20, 95% confidence interval (CI): 1.16–8.80]. The 3-year risk of BOCE was significantly higher in the residual ischemia group (17.8% vs. 5.8%; adjusted HR 2.79, 95% CI: 1.68–4.64), driven by higher incidence of the composite of cardiovascular death and target bifurcation-related myocardial infarction (14.0% vs. 3.3%; adjusted HR 4.06, 95% CI: 2.22–7.42). A significant, inverse association was observed between continuous post-PCI μQFR and the risk of clinical outcomes (per 0.1 μQFR decrease, HR of cardiovascular death 1.27, 95% CI: 1.00–1.62; HR of BOCE 1.29, 95% CI: 1.14–1.47).

Conclusion

After angiographically successful LM bifurcation PCI, residual ischemia assessed by μQFR was identified in 13.2% of patients and was associated with higher risk of 3-year cardiovascular death, indicating the superior prognostic value of post-PCI physiological assessment.

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About the contributors

Hao-Yu Wang

Role: Author

Rui Zhang

Role: Author

Kefei Dou

Beijing (Fuwai Hospital, CAMS and PUMC)

Role: Author