Optical coherence tomography guidance for the management of angiographically intermediate left main bifurcation lesions: Early clinical experience. (1st December 2017)

• Record Type: Journal Article
• Authors: Dato, Ilaria; Burzotta, Francesco; Trani, Carlo; Romano, Andrea; Paraggio, Lazzaro; Aurigemma, Cristina; Porto, Italo; Leone, Antonio Maria; Niccoli, Giampaolo; Crea, Filippo
• Is Part Of: International journal of cardiology. Volume 248(2017)
• Page Start: 108
• Page End: 113
• Publication Date: 2017-12-01
• Subjects: Distal left main -- Frequency domain optical coherence tomography -- Outcome; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2017.06.125
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Left main (LM) atherosclerotic lesions affect clinical outcomes. Frequency domain-optical coherence tomography (FD-OCT) allows detailed characterization of non-ostial coronary atherosclerotic lesions. The clinical impact of FD-OCT assessment of LM bifurcation disease on the revascularization decision is unknown. Methods: Patients who underwent FD-OCT assessment to guide management of angiographically intermediate distal LM stenosis were retrospectively selected. The FD-OCT LM criteria for percutaneous or surgical revascularization were: – LM area stenosis (AS) ≥ 75% – LM AS > 50% < 75% with minimum lumen area < 4 mm 2 or plaque ulceration – critical FD-OCT ostial stenosis on the left anterior descending or circumflex arteries. Clinical follow-up was obtained to evaluate the occurrence of target vessel failure (TVF) defined as cardiac death and/or acute myocardial infarction (AMI) not related to other vessel and/or target vessel revascularization. Results: Out of 131 patients underwent FD-OCT assessment of LM, 122 patients (93%) entered the study. Based on FD-OCT features, 58 (48%) patients were conservatively managed, while the remaining 64 (52%) were revascularized by stenting (n = 48) or surgery (n = 16). After a mean follow-up of 18 months, TVF-free survival was not different between patients undergoing conservative management vs. revascularization (HR 0.40, CI 95% 0.10–1.61, P = 0.20). Of note, two patients only in the conservative management group had TVF (elective LM stenting, no death or myocardial infarction). Conclusions: This preliminary experience suggests that a FD-OCT based management for patients with angiographically-intermediate LM bifurcation stenosis may help identify patients in whom revascularization could be deferred. Such observation calls for further evaluations by appropriately designed trials.