Optimized quantitative angiographic and intravascular ultrasound parameters predicting the functional significance of single de novo lesions in the left anterior descending artery

Background The correlation between angiographic or intravascular ultrasound （IVUS） variables and fractional flow reserve （FFR） in patients with single left anterior descending artery （LAD） lesion has not been studied. The current study aimed at determining the best cutoff value of angiographic and IVUS parameters for defining FFR 〈0.80 in patients with LAD lesion. Methods Quantitative coronary analysis, IVUS and FFR measurements were undergone in 169 patients with single LAD lesion, The best angiographic and IVUS cutoff value and their predictive value for FFR 〈0.80 were compared using area under the receiver-operator characteristic curve （AUC） in overall patients or in subgroups stratified by lesion sites. Results FFR 〈0.80 was found in 99 lesions （58.6%）. Minimal lumen area （MLA）, and plaque burden （PB） were two predictors of FFR 〈0.80. Lesion length had less value in predicting FFR 〈0.80. The cutoff value of PB and MLA for FFR 〈0.80 was 75.4% and 3.03 mm2. MLA and PB had similar high diagnostic value for proximal （cutoff value 3.04 mm2 and 76.5%） and distal LAD lesion （2.82 mm2 and 80.6%）. Combination of MLA （2.82 mm2） and PB （80.6%） had increased diagnostic value for distal LAD lesion. Conclusions MLA and plaque burden had equivalent diagnostic value for FFR 〈0.80 when lesion localized in LAD. The predictive value of combination of MLA and plaque burden for distal LAD lesion was strengthened.

Efficacy and safety of Firebird sirolimus-eluting stent in treatment of complex coronary lesions in Chinese patients： one-year clinical and eight-month angiographic outcomes from the FIREMAN registry

Background Off-label application of drug-eluting stents （DES） during percutaneous coronary intervention （PCI） was not uncommon in daily practice, however DES in treating Chinese patients with complex lesion subset was under-investigated. The primary objective of the FIREMAN registry was to evaluate the long term efficacy and safety of the Firebird sirolimus-eluting stent （SES） in treating patients with complex coronary lesions. Here we report the mid-term of one-year clinical outcomes and eight-month angiographic follow-up results of FIREMAN registry.Methods The FIREMAN registry was a prospective multi-center registry, which included 1029 consecutive patients undergoing PCI with Firebird SES implantation between September 2006 and July 2007 in 45 centers in China. The clinical follow-up was designed to be performed at 1, 6, 12, 18, 24, 30 and 36 months post index procedure, and non-mandatory angiographic follow-up at 8 months was planned. One hundred percent site monitoring was conducted.Results Long lesions （59.2%）, multi-vessel disease （50.4%）, and small vessel disease （31.6%） were mostly found in angiography. Major adverse cardiac events （MACE） occurred in 51 （5.1%） patients at 1 year clinical follow-up,including cardiac mortality in 6 （0.6%）, non-fatal myocardial infarction in 11 （1.1%）, and target lesion revascularization in 36 （3.5%） of the patients. Definite and probable stent thrombosis （ST） by Academic Research Consortium （ARC） definition occurred in 12 （1.36%） patients at one-year clinical follow-up. The 8-month binary restenosis rate was 5.7% in-segment and 4.3% in-stent, respectively. Late lumen loss was （0.21±0.40） mm in-segment and （0.23±0.36） mm in-stent, respectively. Furthermore, Cox regression analysis revealed that diabetes, small vessel diameter, and chronic total occlusion were independent predictors of ST.Conclusions The results showed that the Firebird SES was effective and safe in treating Chinese patients with complex coronary lesions and occurrence of ST rate at one-year clinical follow-up was acceptable, however further long-term follow-up was still necessary. （NCT00552656）