Photo Credit: Bulgakova Kristina
The following is a summary of “Deferral of left main coronary artery revascularization via IVUS or coronary physiology – Long-term outcomes from the SWEDEHEART registry,” published in the November 2024 issue of Cardiology by Berntorp et al.
Intravascular ultrasound (IVUS) and coronary physiology (iFR and FFR) are used to guide decisions regarding left main coronary artery (LMCA) revascularization, with IVUS improving outcomes. More studies are needed to assess the role of coronary physiology in decision-making.
Researchers conducted a retrospective study to evaluate the outcomes of deferring LMCA revascularization using IVUS or coronary physiology iFR or FFR.
They included patients from the SWEDEHEART registry between January 2014 and February 2022 who underwent IVUS and iFR, or FFR evaluation of the LMCA. Exclusion criteria were minimum luminal area <6 mm2, iFR ≤ 0.89, FFR ≤ 0.80, ad hoc percutaneous coronary intervention (PCI) of LMCA lesions, proximal left anterior descending artery, proximal circumflex artery, planned elective revascularization, and planned valvular surgery. The primary outcome, major adverse cardiac events (MACE), were analyzed, which included all-cause death, myocardial infarction (MI), and unplanned revascularization, using Kaplan-Meier and multivariable Poisson regression.
The result showed 1,552 patients deferred revascularization of the LMCA, with 33.6% using IVUS and 66.4% using coronary physiology (11.3% iFR vs. 55.0% FFR). The median follow-up was 2.7 years, with no significant difference in MACE (IVUS 40.2% vs. coronary physiology 35.5%; adjusted relative risk [RR] 1.18; 95% CI 0.97–1.44; P=0.09). The rate of all-cause death was higher in the IVUS group (aRR 1.38; 95% CI 1.03–1.83; P=0.03).
They concluded that deferral of LMCA revascularization using IVUS or iFR and FFR did not differ in the primary outcome, though a higher risk of all-cause death was observed with IVUS.
Source: internationaljournalofcardiology.com/article/S0167-5273(24)01348-2/abstract
