Angiographic underestimation of LAD lesions.

Borren, N. (Nanette) (2015) Angiographic underestimation of LAD lesions. thesis, Medicine.

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Abstract

Background: Invasive coronary angiography may both over- and underestimate the functional importance of a coronary stenosis. Previous studies suggested that the functional severity of lesions of the left anterior descending artery (LAD) are more often underestimated when assessed visually (reverse mismatch), in comparison with non-LAD lesions, but evidence is limited. As a result of reverse mismatch, significant abnormalities can be missed and patients do not receive appropriate treatment. Aim: The purpose of this study is to compare the prevalence of reverse mismatch of LAD lesions with non-LAD lesions. Methods: Fractional flow reserve (FFR) was performed in 260 patients with stable coronary artery disease (335 coronary stenoses: 187 LAD lesions and 148 non-LAD lesions (RCA=58, LM=15, CX=75)). A visually assessed diameter stenosis of ≥70% was considered significant. A cut-off value of ≤ 0.80 was defined as abnormal FFR. To adjust for differences in baseline variables, multivariable analyses were performed. Results: Mean age of the total population was 65 ±10 years. Patients with LAD lesions more often had diabetes compared to patients with non-LAD lesions, other baseline characteristics were comparable. Angiographically, LAD lesions, as well as non-LAD lesions were considered significant in 29% (p=0.94). FFR demonstrated significant stenosis of the LAD in 52%, in comparison with 24% in non-LAD lesions (p<0.001). Reverse mismatch was observed in 30% of LAD lesions, compared with 11% in non-LAD lesions (p<0.001). The adjusted odds ratio for reverse mismatch in LAD lesions in comparison with non-LAD lesions was 3.48 (95% confidence interval 1.89- 6.41; p<0.001). Conclusion: Underestimation of the functional severity of a coronary stenosis (reverse mismatch) is significantly more common in LAD lesions. FFR should be performed more often for intermediate stenoses of the LAD.

Item Type:	Thesis (Thesis)
Supervisor name:	Ottervanger, Jan Paul MD PhD FESC and Department of Cardiology and Isala Hospital, Zwolle
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:51
Last Modified:	25 Jun 2020 10:51
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1187

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