Abstract 16974: Safety of Deferral of Revascularization Following Invasive Assessment of Intermediate Left Main Coronary Artery Disease. A Meta-Analysis of Comparative Clinical Studies
Background: Invasive assessment of unprotected intermediate left main coronary artery disease (ILMCAD), using fractional flow reserve (FFR) or intravascular ultrasound (IVUS), is increasingly performed. The safety of deferral of revascularization in these patients based on invasive assessment remains poorly described.
Methods: An extensive literature search (1/1/01-2/28/13) yielded 12 studies that utilized FFR- and IVUS-assessment to guide revascularization decisions among patients with ILMCAD (revascularization ‘revasc’ vs. deferral of revascularization ‘defer’). Computed outcomes included death, myocardial infarction (MI), and revascularization at 12 months and long-term follow-up (mean 30.7±9.1 months). Odds ratios and their 95% confidence intervals were utilized to summarize the effects size for each outcome using the random-effects model.
Results: We identified 8 FFR and 4 IVUS studies reporting comparative clinical outcomes in 1,308 patients with ILMCAD, who underwent revascularization or deferral of revascularization based on either FFR (revasc=238, defer=357) or IVUS (revasc=307, defer=406) assessment. The ‘revasc’ and ‘defer’ groups had comparable baseline characteristics in both FFR and IVUS studies. Among patients with ILMCAD, deferral of revascularization based on invasive assessment with FFR or IVUS was not associated with increased death or MI compared with revascularized patients, but was associated with an expected increase in the need for future revascularization (Table).
Conclusions: Deferral of revascularization for ILMCAD following invasive assessment (by IVUS or FFR) appears to be safe and not associated with increased MI or death. Our report however underscores the paucity of evidence (small numbers and limited follow-up) to support the routine use of invasive assessment of ILMCAD to dictate revascularization strategies.
- © 2013 by American Heart Association, Inc.