Anglia Ruskin Research Online (ARRO)
warisawa-et-al-2023-deferred-versus-performed-revascularization-for-left-main-coronary-disease-with-hemodynamic.pdf (770.43 kB)

Deferred versus performed revascularization for left main coronary disease with hemodynamic significance

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posted on 2024-02-02, 16:38 authored by Takayuki Warisawa, Christopher M Cook, Yousif Ahmad, James P Howard, Henry Seligman, Christopher Rajkumar, Takumi Toya, Shunichi Doi, Akihiro Nakajima, Masafumi Nakayama, Rafael Vera-Urquiza, Sonoka Yuasa, Takao Sato, Yuetsu Kikuta, Yoshiaki Kawase, Hidetaka Nishina, Rasha Al-Lamee, Sayan Sen, Amir Lerman, Hitoshi Matsuo, Yoshihiro J Akashi, Javier Escaned, Justin E Davies
Background: The majority of randomized controlled trials of revascularization decision-making excludes left main coronary artery disease (LMD). Therefore, contemporary clinical outcomes of patients with stable coronary artery disease and LMD with proven ischemia remain poorly understood. The aim of this study was to assess the long-term clinical outcomes of physiologically significant LMD according to the treatment strategies of revascularization versus revascularization deferral. Methods: In this international multicenter registry of stable LMD interrogated with the instantaneous wave-free ratio, patients with physiologically significant ischemia (instantaneous wave-free ratio ≤0.89) were analyzed according to the coronary revascularization (n=151) versus revascularization deferral (n=74). Propensity score matching was performed to adjust for baseline clinical characteristics. The primary end point was a composite of death, nonfatal myocardial infarction, and ischemia-driven target lesion revascularization of left main stem. The secondary end points were as follows: cardiac death or spontaneous LMD-related myocardial infarction; and ischemia-driven target lesion revascularization of left main stem. Results: At a median follow-up period of 2.8 years, the primary end point occurred in 11 patients (14.9%) in the revascularized group and 21 patients (28.4%) in the deferred group (hazard ratio, 0.42 [95% CI, 0.20–0.89]; P =0.023). For the secondary end points, cardiac death or LMD-related myocardial infarction occurred significantly less frequently in the revascularized group (0.0% versus 8.1%; P =0.004). The rate of ischemia-driven target lesion revascularization of left main stem was also significantly lower in the revascularized group (5.4% versus 17.6%; hazard ratio, 0.20 [95% CI, 0.056–0.70]; P =0.012). Conclusions: In patients who underwent revascularization for stable coronary artery disease and physiologically significant LMD determined by instantaneous wave-free ratio, the long-term clinical outcomes were significantly improved as compared with those in whom revascularization was deferred.



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Circulation: Cardiovascular Interventions




Ovid Technologies (Wolters Kluwer Health)


United States

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  • Published version


  • eng

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Article, Journal

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  • School of Medicine Outputs