Optimal Meds May Be Enough for Intermediate-Severity Secondary Coronary Lesions

Sherrie R. Webb, PA-C, for Medscape

April 26, 2022

The study covered in this summary was published on ResearchSquare.com as a preprint and has not yet been peer-reviewed.

Key Takeaways

  • In patients with significant coronary lesions (>70%) on angiography, those who also have lesions of intermediate (IL) severity (30% - 70%) in other major coronary arteries have acceptable clinical outcomes, including late IL-related revascularization, when IL management does not go beyond optimal medical therapy.

  • The 10-year risk for major adverse cardiovascular events (MACE) is increased in such patients with right coronary artery IL, and it goes up overall with increasing IL number.

  • Still, in patients with stenosis of more than 70% and other IL lesions, optimal medical treatment may be considered an alternative to IL revascularization guided by routine functional assessment, such as measurement of fractional flow reserve (FFR).

Why This Matters

  • Acute coronary syndrome can develop in patients with coronary lesions that are significant or of IL severity. The current study might be the first to assess long-term clinical outcomes in patients with significant coronary lesions accompanied by ILs in a different coronary artery that are managed with optimal medical therapy.

  • The results suggest that, in patients with significant coronary stenoses, a conservative approach to managing ILs in other coronary arteries is appropriate in lieu of functionally guided revascularization.

Study Design

  • The retrospective observational study involved 403 patients with at least one significant lesion identified at coronary angiography performed for suspected ischemic heart disease over 1 year at Konyang University Hospital, South Korea.

  • Patients who were and were not determined also to have IL stenoses in other coronaries, by visual estimation from coronary angiograms, were compared for MACE over a follow-up averaging 119 months.

  • Subjects were categorized as IL(+) or IL(-), based on presence or absence of intermediate stenoses (defined as 30% to 70% by visual estimation) in other major coronary arteries.

  • All patients received optimal medical therapy.

  • The primary endpoint was MACE during the 10-year follow-up period, defined as all-cause death, myocardial infarction (MI), stroke, or revascularization.

Key Results

  • Most of the cohort, 83.6%, underwent percutaneous coronary intervention (PCI) of their significant coronary stenoses. They included 85.0% of IL(+) patients and 82.5% of IL(-) patients.

  • The 10-year rate of MACE trended higher, short of significance, in the IL(+) group than in the IL(-) group (37.4% vs 29.2%; P = .079). The same trend was observed for the individual MACE components.

  • The 10-year rate of revascularization was lower for IL lesions than for the significant lesions (5.2% and 13.2%, respectively).

  • Number of IL stenoses and ejection fraction were independently predictive of MACE. Right coronary artery IL location and hypertension were independently predictive of revascularization. Number of IL stenoses was independently predictive of IL-related revascularization.

Limitations

  • Selection bias could not be excluded because of the single-center, retrospective nature of the study.

  • The study did not evaluate lesion length or morphology.

  • The study could not account for the effect of medications or changes in medications on clinical outcomes.

Disclosures

  • The study received no commercial funding.

  • None of the authors disclosed relevant financial relationships.

This is a summary of a preprint research study, Effect of intermediate lesions on the 10-years clinical outcomes in patients with significant coronary artery disease, written by Yong Kyun Kim, from Konyang University Hospital, Daejeon, South Korea, and colleagues on ResearchSquare.com provided to you by Medscape. This study has not yet been peer-reviewed. The full text of the study can be found on ResearchSquare.com.

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