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Comprehensive Assessment of Left Main Coronary Artery Stenosis Utilizing Pressure Wire: A Retrospective Analysis
Session:
Sessão de Posters 42 - Revascularização de tronco comum
Speaker:
Tatiana Pereira dos Santos
Congress:
CPC 2024
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.2 Coronary Intervention
Session Type:
Cartazes
FP Number:
---
Authors:
Tatiana Pereira Dos Santos; Mariana Rodrigues Simões; Gonçalo Terleira Batista; Ana L. Silva; Rafaela Fernandes; Vanessa Lopes; Diogo Fernandes; Gonçalo Costa; Joana Guimarães; Elisabete Jorge; Luís Leite; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:#333333">Background: Pressure wire evaluation (PWE) serves as a pivotal tool in guiding revascularization decisions for coronary lesions, providing a coronary index flow that prevents overtreatment and facilitates clinical decision-making. Left main (LM) coronary stenosis is associated with increased mortality and a poorer prognosis. The aim of this study was to assess the long-term clinical outcomes of patients with stenosis in whom treatment strategy was based on PWE.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:#333333">Methods: A retrospective analysis was conducted on patients who underwent PWE between January 2018 and December 2022 at a Portuguese tertiary center. PWE methods used included fractional flow reserve and instantaneous wave-free ratio, employing cut-off points of ≤0.80 and ≤0.89, respectively.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:#333333">Results: Among the 71 patients with LM disease assessed using PWE, 87.3% were male, with a mean age of 68.2 ± 9.6 years. The median follow-up time was 1185 (IQR 880) days. Predominantly, 85.7% had hypertension, 37.1% diabetes, and 18.1% heart failure (HF) with reduced or mildly reduced ejection fraction. Notably, 43.7% had a history of acute coronary syndrome (ACS) and PWE was performed in this context (ACS) in 29.6% of cases. Angiography exhibited 52.1% patients with multivessel disease (MVD). PWE identified 24 patients with significant LM disease who underwent revascularization (R), while 41 without significant disease were managed medically (MT). Some patients with significant disease were not revascularized by decision of heart team. No significant differences emerged between groups concerning risk factors, lesion type, MVD, chronic or ostial occlusions. Overall mortality was numerically higher in revascularized patients (R: 12.5% versus MT: 9.8%, p=0.7), whereas cardiovascular death was lower (R: 4.2% versus MT: 7.3%, p=1.0). HF rehospitalization appeared similar (R: 4.2% versus MT: 4.9%, p=1.0). Elevated mortality was associated with the presence of chronic kidney disease (CKD) (OR 26.7, 95% CI 4.0-177.1, p=0.001) and left ventricular ejection fraction <50% (OR 8.2, 95% CI 1.6-42.6, p=0.018). Logistic regression, with potential confounders, showed significance only for CKD (p=0.003). No complications were observed during PWE.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:#333333">Conclusion: Deferral of revascularization for LM stenosis based on PWE appears to be safe,</span></span></span> <span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:#333333">with similar long-term outcomes to those in whom LM revascularization was performed according to PWE values. CKD emerges as a mortality factor, while other factors lack significant associations.</span></span></span></span></span></p>
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