Long-term results of percutaneous coronary interventions in patients with diffuse and multivessel coronary artery diseases

Abstract

Highlights. Two-year results of stenting in patients with diffuse and multivessel coronary artery lesions performed using intravascular research and control methods (optical coherence tomography, blood flow fractional reserve) are presented. A low incidence of myocardial infarction, repeated interventions and a high level of survival, free from significant cardiovascular complications, were noted when using intravascular research methods in patients during percutaneous coronary intervention in comparison with the patients who did not undergo intravascular methods.Aim. To evaluate the two-year results of percutaneous coronary interventions (PCI) in patients with diffuse and multivessel coronary lesions.Methods. 128 patients were included in the study and divided into two groups. In group I (n = 62) PCI was performed using intravascular imaging methods, in group II (n = 66) no intravascular imaging methods (retrospectively) were used. The measurement of fractional flow reserve (FFR) in diffusely altered arteries was performed against the background of maximum hyperemia between stenoses by pulling the sensor starting from the distal segment. Initially, the most distal hemodynamically significant stenosis underwent the stenting. Then, a repeated measurement of FFR was performed and it showed if the further stenting was needed. The results of stenting, as well as the determination of the stent implantation area were carried out by the method of optical coherence tomography.Results. 12 months after PCI the results of treatment were checked in all patients and after 24 months – in 106 patients (56 and 50, respectively, in groups I and II). The achievement of complete (functionally adequate, according to FFR measurements) myocardial revascularization was achieved in 93.5% of patients from group I, while the result in the control group was only 56% of patients. The average number of stenoses in the target non-occluded artery according to angiography and after FFR measurement was the following: in patients with two-vessel lesions – 2.95±0.65 and 1.82±0.88, respectively, and in patients with three-vessel lesions – 2.96±0.6 and 2.24±0.76, respectively (p = 0.0024). After 12 months of follow-up, significant differences were observed between groups I and II in the frequency of myocardial infarction (1.8 and 4.0%, respectively; χ2 = 5.172) and repeated interventions (3.6 and 16.0%, respectively; χ2 = 8.114). By the 24th month of follow-up, among the observed patients, the total frequency of myocardial infarction, repeated interventions and cardiac death were significantly higher in patients of group II compared with group I and they were 45.5 and 9.6%, respectively (χ2 = 14.784; p<0,0001).Conclusion. Long-term results of PCI in patients with diffuse and multivessel coronary lesions using intravascular imaging methods (optical coherence tomography and FFR measurements) are characterized by low cardiac complications, compared with patients operated without imaging methods.