Abstract
The data about FFR-guided revascularization in isolated proximal LAD disease are limited and studies comparing long-term outcomes of FFR-guided PCI versus FFR-guided CABG in single-vessel proximal LAD disease are lacking. We aimed to assess the 4-year long-term safety and effectiveness of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) and FFR-guided coronary artery bypass graft surgery (CABG) for the treatment of proximal left anterior descending (LAD) lesions. The study included 129 patients with functionally significant (FFR ≤ 0.80) isolated proximal LAD stenosis (PCI, 88 patients vs. CABG, 41). Clinical endpoints were assessed by Kaplan-Meier method and compared by the log-rank test. At a mean follow-up time of 47 ± 12 months, a higher incidence of myocardial infarction in the PCI group (PCI: 32% vs. CABG: 15%; p = 0.003) and a higher incidence of stroke in the CABG group (CABG: 3 (7%) vs. PCI 0 (0%); p = 0.031) were observed. However, there were no significant differences in the primary composite endpoint, death and target vessel revascularization between PCI and CABG groups. The PCI and CABG in isolated proximal LAD lesions yielded similar long-term outcomes regarding the primary composite clinical endpoints. However, stroke was more frequent in the CABG group than in the PCI group.
Highlights
The presence of a significant obstructive coronary lesion of the proximal left anterior descending coronary artery (LAD) is a commonly approved indication for treatment by either percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG) [1] [2] [3]
Among baseline demographic characteristics except for hypertension, smoking and creatinine levels, there were no differences between the CABG and PCI groups
In the PCI group, the percentage of the patients with hypertension was significantly higher than the CABG group (75% vs. 54%, p = 0.015)
Summary
The presence of a significant obstructive coronary lesion of the proximal left anterior descending coronary artery (LAD) is a commonly approved indication for treatment by either percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG) [1] [2] [3]. The gold-standard method to detect coronary artery disease is still coronary angiography. Coronary angiography has been used to determine lesion severity, in moderate coronary artery stenosis (50% - 70%), the presence of ischemia is uncertain. Coronary flow reserve and fractional flow reserve (FFR) are developed in order to assess hemodynamically important coronary artery stenosis. FFR is a pressure-wire-based index that is utilized during coronary angiography to evaluate the coronary artery stenosis severity by inducing myocardial ischemia [7] [8] [9]. If there is an increase in microvascular resistance in the coronary artery, the ratio of FFR is decreased
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