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Left main bifurcation stenting: impact of residual ischaemia on cardiovascular mortality
AIMS: 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 RESULT...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10627280/ https://www.ncbi.nlm.nih.gov/pubmed/37188864 http://dx.doi.org/10.1093/eurheartj/ehad318 |
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author | Wang, Hao-Yu Zhang, Rui Dou, Kefei Huang, Yunfei Xie, Lihua Qiao, Zheng Zou, Tongqiang Guan, Changdong Song, Lei Yang, Weixian Wu, Yongjian Tu, Shengxian Wijns, William Xu, Bo |
author_facet | Wang, Hao-Yu Zhang, Rui Dou, Kefei Huang, Yunfei Xie, Lihua Qiao, Zheng Zou, Tongqiang Guan, Changdong Song, Lei Yang, Weixian Wu, Yongjian Tu, Shengxian Wijns, William Xu, Bo |
author_sort | Wang, Hao-Yu |
collection | PubMed |
description | AIMS: 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. |
format | Online Article Text |
id | pubmed-10627280 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-106272802023-11-07 Left main bifurcation stenting: impact of residual ischaemia on cardiovascular mortality Wang, Hao-Yu Zhang, Rui Dou, Kefei Huang, Yunfei Xie, Lihua Qiao, Zheng Zou, Tongqiang Guan, Changdong Song, Lei Yang, Weixian Wu, Yongjian Tu, Shengxian Wijns, William Xu, Bo Eur Heart J Fast Track Clinical Research AIMS: 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. Oxford University Press 2023-05-16 /pmc/articles/PMC10627280/ /pubmed/37188864 http://dx.doi.org/10.1093/eurheartj/ehad318 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Fast Track Clinical Research Wang, Hao-Yu Zhang, Rui Dou, Kefei Huang, Yunfei Xie, Lihua Qiao, Zheng Zou, Tongqiang Guan, Changdong Song, Lei Yang, Weixian Wu, Yongjian Tu, Shengxian Wijns, William Xu, Bo Left main bifurcation stenting: impact of residual ischaemia on cardiovascular mortality |
title | Left main bifurcation stenting: impact of residual ischaemia on cardiovascular mortality |
title_full | Left main bifurcation stenting: impact of residual ischaemia on cardiovascular mortality |
title_fullStr | Left main bifurcation stenting: impact of residual ischaemia on cardiovascular mortality |
title_full_unstemmed | Left main bifurcation stenting: impact of residual ischaemia on cardiovascular mortality |
title_short | Left main bifurcation stenting: impact of residual ischaemia on cardiovascular mortality |
title_sort | left main bifurcation stenting: impact of residual ischaemia on cardiovascular mortality |
topic | Fast Track Clinical Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10627280/ https://www.ncbi.nlm.nih.gov/pubmed/37188864 http://dx.doi.org/10.1093/eurheartj/ehad318 |
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