Fractional Flow Reserve in Choosing the Tactics of Interventional Treatment of Multilevel Coronary Artery Lesions

Andrii Yu. Gavrylyshyn; Sergii V. Salo; Olena V. Levchyshyna; Andrii K. Logutov; Vasyl V. Lazoryshynets

doi:10.30702/ujcvs/21.4512/GS060-2629

Andrii Yu. Gavrylyshyn National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0002-2942-6190
Sergii V. Salo National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0001-5456-1418
Olena V. Levchyshyna National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0003-0276-4533
Andrii K. Logutov National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0001-5857-3010
Vasyl V. Lazoryshynets National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0002-1748-561X

DOI: https://doi.org/10.30702/ujcvs/21.4512/GS060-2629

Keywords: stable ischemic heart disease, invasive diagnostics, functional revascularization, fractional reserve of coronary blood flow, hemodynamic significance, multilevel lesions of the coronary artery

Abstract

When choosing tactics for the treatment of patients with stable coronary artery disease, invasive coronary angiography remains the gold standard for diagnosis and is a crucial method in choosing tactics and volume of revascularization. However, in the presence of borderline (>50-70%), multilevel lesions of the coronary artery, there is a need for additional assessment of the physiological significance of each stenosis.

The aim. To develop an algorithm to optimize the use of fractional flow reserve (FFR) measurement in interventional treatment of borderline (>50-70%), multilevel lesions of coronary arteries, to show the safety of “functional revascula rization” in comparison with traditional angiography.

Materials and methods. The study included 32 patients who were treated at the National Amosov Institute of Cardiovascular Surgery in the period from 2017 to 2021 (the vast majority were men – 25 patients (67%) and 7 (33%) women) aged 60.3±8.3 years who had >50-75% multilevel lesions of one of the main coronary arteries according to selective invasive coronary angiography. The patients were divided into two groups: 1) Angiographic group (n = 17, 53%), where the volume and tactics of revascularization were determined only by angiography (maximum complete anatomical revascularization); 2) Functional group (n=15, 47%) (combination of angiography data and FFR measurement, the so-called “functional revascularization”).

Conclusions. An effective and safe algorithm for measuring FFR in multilevel lesions (reducing the number of implanted stents) is shown.

References

Khan MA, Hashim MJ, Mustafa H, Baniyas MY, Al Suwaidi SKBM, AlKatheeri R, Alblooshi FMK, Almatrooshi MEAH,Alzaabi MEH, Al Darmaki RS, Lootah SNAH. Global Epidemiology of Ischemic Heart Disease: Results from the GlobalBurden of Disease Study. Cureus. 2020;12(7):e9349. https://doi.org/10.7759/cureus.9349
Nowbar AN, Gitto M, Howard JP, Francis DP, Al-Lamee R. Mortality From Ischemic Heart Disease. Circ Cardiovasc Qual Outcomes. 2019;12(6):e005375. https://doi.org/10.1161/CIRCOUTCOMES.118.005375
Inohara T, Kohsaka S, Spertus JA, Masoudi FA, Rumsfeld JS, Kennedy KF, Wang TY, Yamaji K, Amano T, Nakamura M. Comparative Trends in Percutaneous Coronary Intervention in Japan and the United States, 2013 to 2017. J Am Coll Cardiol. 2020;76(11):1328-40. https://doi.org/10.1016/j.jacc.2020.07.037
Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019;40(2):87-165. https://doi.org/10.1093/eurheartj/ehy394
Pellikka PA, Arruda-Olson A, Chaudhry FA, Chen MH, Marshall JE, Porter TR, Sawada SG. Guidelines for Performance, Interpretation, and Application of Stress Echocardiography in Ischemic Heart Disease: From the American Society of Echocardiography. J Am Soc Echocardiogr. 2020;33(1):1-41.e8. https://doi.org/10.1016/j.echo.2019.07.001
Echavarría-Pinto M, Collet C, Escaned J, Piek JJ, Serruys PW. State of the art: pressure wire and coronary functional assessment. EuroIntervention. 2017;13(6):666-79. https://doi.org/10.4244/EIJ-D-17-00503
Pijls NH, De Bruyne B, Bech GJ, Liistro F, Heyndrickx GR, Bonnier HJ, Koolen JJ. Coronary pressure measurement to assess the hemodynamic significance of serial stenoses within one coronary artery: validation in humans. Circulation. 2000;102(19):2371-7. https://doi.org/10.1161/01.cir.102.19.2371
Kumbhani DJ, Bhatt DL. Fractional Flow Reserve in Serial Coronary Artery Stenoses. JAMA Cardiol. 2016;1(3):359-60. https://doi.org/10.1001/jamacardio.2016.0219
Nogic J, Prosser H, O’Brien J, Thakur U, Soon K, Proimos G, Brown AJ. The assessment of intermediate coronarylesions using intracoronary imaging. Cardiovasc Diagn Ther. 2020;10(5):1445-60. https://doi.org/10.21037/cdt-20-226
Tobis J, Azarbal B, Slavin L. Assessment of Intermediate Severity Coronary Lesions in the Catheterization Laboratory. J Am Coll Cardiol. 2007;49(8):839-48. https://doi.org/10.1016/j.jacc.2006.10.055