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Decision failure in ambiguous lesions assessed by coronary physiology evaluation
Session:
Posters - H. Interventional Cardiology and Cardiovascular Surgery
Speaker:
Rita Rocha
Congress:
CPC 2021
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.1 Invasive Imaging and Functional Assessment
Session Type:
Posters
FP Number:
---
Authors:
Rita Caldeira Da Rocha; João Pais; Francisco Cláudio; Mafalda Carrington; Marisa Serrano; Diogo Brás; David Neves; Ângela Bento; Renato Fernandes; Manuel Trinca; Lino Patrício
Abstract
<p>Introduction:The potential benefit of revascularization depends on presence and extension of myocardial ischemia.Important complications can derive from revascularization, so evidence of benefit is crucial to justify the risk of the procedure. Coronary physiology has a significant role on this evaluation, especially for intermediate lesions.</p> <p>Objectives:The aim of this study is to determine the prevalence and impact of treatment decision failure of ambiguous lesions assessed by coronary physiology evaluation (PE).</p> <p>Methods:Retrospective study, including all consecutive patients who performed PE in our center between December 2013 and December 2018, with clinical follow-up. The primary endpoint of this follow-up was a composite called Decision Failure(DF), and was defined as clinically-driven target lesion(TL)revascularization, and TL-related Acute Coronary Syndrome. TL was defined as the treated segment, when treated(due to positive PE),or the evaluated segment, when deferred(negative PE).Additionally, Myocardial Infarction(MI),Unstable Angina(UA)and all-cause mortality were sought after.</p> <p>Results: A total of 256 lesions in 182 patients were analyzed with a mean follow-up of 26±12months. Male patients accounted for 57%, with a mean age of 67±10years old. Hypertensive patients accounted for 63%, 41% had diabetes and 32% had history smoking habits. The main reason for performing coronariography was due to treadmill stress test (39%) or imaging techniques (19%). In 11% of the patients, non-culprit PE was done in a NSTEMI context. In 7 cases, PE was attempted, but not achieved, due to technical problems. Different techniques were executed: iFR (69%), contrast hyperemia (38%) and FFR (40%). PE lead to revascularization of 63 and deferral of 193 lesions. In 6 cases, PE was borderline negative, but the decision was to perform revascularization, due to anatomical evaluation with IVUS. Only one (0.4%) possible complication was observed: dissection possibly due to physiology guide- wire progression, which was resolved with a stent implantation. DF was observed in 4% of patients, being TL failure present in 3%: 1 presenting with STEMI, 2 with NSTEMI and 2 UA, with a mean of 7±3months after PE. All of the events were observed after deferred intervention due to negative PE. Globally, UA was found in 5% (n=10) and MI in 4%(n= 8) of patients after a median follow-up of 12[4;15]and 20[9;43]months, respectively. Mortality during follow-up occurred in 7%(n=12) of patients, only one possibly related with TL failure(3years after negative evaluation).</p> <p>Conclusion: Revascularization based on PE has been proved to be useful(decision on 256 lesions otherwise ambiguous),safe(0.4% complications)and efficient(DF 4%) technique.</p>
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