Stenting of coronary artery bifurcation lesions can be challenging, especially given the potential compromise of blood flow into the “jailed” side branch. After stenting, optimal results are obtained by assessing fractional flow reserve (FFR) in the side branch.
Such functional assessment is considered more reliable than angiographically determined stenosis, which tends to overestimate the lesion’s functional severity. Whether or not clinical outcome also improves as a result of this approach remains unclear however, as long-term follow-up is scarce. Outcome may also depend on the exact location of the stented lesion.
In a recent study published in JACC Cardiovascular Intervention, Lee et al. describe a cohort of 83 patients with distal left main coronary artery (LM) lesions who underwent simple crossover stenting of the LM followed by FFR measurement in the jailed left circumflex coronary artery (LCx). The rate of target lesion failure was determined at five years.
FFR threshold and outcome
They found a lack of correlation between LCx stenosis in quantitative angiography and FFR. After five years, the 14 patients with low FFR (defined as ≤0.80) had a significantly higher incidence of target lesion failure than those with high FFR (33.4% vs. 10.7%; hazard ratio: 4.09, 95% confidence interval: 1.15 to 14.52; p = 0.029). A low FFR value was also an independent predictor of events.
Patients with a high FFR clearly had better five-year outcomes than those with low FFR. The authors therefore suggest that FFR measurements in jailed LCx can be used to improve the selection of adequate treatment strategies, thereby avoiding unnecessary complex procedures.
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Author: Sally Hill
Original article: JACC Cardiovasc Interv 2019;12(9):847-855.