Author + information
- Jung–Min Ahn,
- Seungmo Kang,
- Young–Rak Cho,
- Gyung–Min Park,
- Jong–Young Lee,
- Won–Jang Kim,
- Soo–Jin Kang,
- Duk–Woo Park,
- Seung–Whan Lee,
- Young–Hak Kim,
- Cheol Whan Lee,
- Seong–Wook Park and
- Seung–Jung Park
Optimal and safe threshold of fractional flow reserve (FFR) to determine revascularization of significant left main coronary (LMCA) stenosis has been in debate. To evaluate the cut–off value of FFR in intermediate isolated LMCA stenosis to detect the myocardial ischemia as compared with stress myocardial single–photon emission computed tomography (SPECT).
Between April 2010 and May 2012, 38 patients with isolated intermediate LCMA stenosis underwent stress myocardial SPECT within 1 month before coronary angiogram and fractional flow reserve (FFR) measurement during coronary angiogram.
FFR is significantly lower in LMCA stenosis with positive SPECT than those with negative SPECT (0.68±0.08 vs. 0.81±0.07, p<0.001). Receiver–operating curve analysis showed that the optical cut–off value of FFR was ≤ 0.74 to detect the positive SPECT (area under the curve: 0.89 [95% CI; 0.74–0.97, p<0.001]) with a 93% sensitivity, a 78% specificity, a 74% positive predictive value, and a 95% negative predictive value. Overall diagnostic accuracy was 84% (kappa=0.68, p<0.001). Based on the FFR of 0.80, 25 patients underwent percutaneous coronary intervention and LMCA revascularization was deferred in 13 patients. During median follow–up of 20.8 (interquartile range: 9.8, 26.9) months, 2 repeat revascularization was occurred without death or myocardial infarction (2 year event free survival rate: 93.2±4.2%).
In isolated intermediate LMCA stenosis, optimal cut–off value of FFR to detect myocardial ischemia is ≤0.74, which suggested that currently used cut–off value of FFR derived from epicardial coronary artery stenosis could be safely applied to determine the revascularization of LMCA stenosis.
West, Room 2022
Saturday, March 09, 2013, 9:00 a.m.–9:10 a.m.
Session Title: Left Main and Bifurcation PCI
Abstract Category: 46. TCT@ACC–i2: Coronary Intervention, LM/Bifurcations
Presentation Number: 2901–5
- 2013 American College of Cardiology Foundation