Assessment of left main coronary artery disease: a comparison between invasive and noninvasive

Left main coronary artery disease has significant therapeutic as well as prognostic implications. The presence of left main coronary artery stenosis is strongly associated with poor short- and long-term prognoses. Accurate identification of left main stenosis is extremely important since it would be the main factor to guide management. There are several modalities used to determine the presence of atherosclerosis and the degree of stenosis in a left main coronary artery. Newer modalities allow for an accurate evaluation of left main stenosis and atherosclerosis. In this review, we go through different invasive and noninvasive modalities to diagnose left main stenosis, shedding more light into coronary computed tomography angiography, and its accuracy in this specific diagnosis.

[1]  D. Berman,et al.  Sex-based prognostic implications of nonobstructive coronary artery disease: results from the international multicenter CONFIRM study. , 2014, Radiology.

[2]  F. Alfonso,et al.  Prospective application of pre-defined intravascular ultrasound criteria for assessment of intermediate left main coronary artery lesions results from the multicenter LITRO study. , 2010, Journal of the American College of Cardiology.

[3]  D. Berman,et al.  Sex-Specific Associations Between Coronary Artery Plaque Extent and Risk of Major Adverse Cardiovascular Events: The CONFIRM Long-Term Registry. , 2016, JACC. Cardiovascular imaging.

[4]  Gary S Mintz,et al.  Intravascular imaging of coronary calcification and its clinical implications. , 2015, JACC. Cardiovascular imaging.

[5]  R. Detrano,et al.  Relationship between baseline coronary calcium score and demonstration of coronary artery stenoses during follow-up MESA (Multi-Ethnic Study of Atherosclerosis). , 2009, JACC. Cardiovascular imaging.

[6]  R. Hobbs,et al.  Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. , 1990, Catheterization and cardiovascular diagnosis.

[7]  Fumiaki Ikeno,et al.  Fractional Flow Reserve Assessment of Left Main Stenosis in the Presence of Downstream Coronary Stenoses , 2012, Circulation. Cardiovascular interventions.

[8]  D. Berman,et al.  Long-Term Prognostic Utility of Coronary CT Angiography in Stable Patients With Diabetes Mellitus. , 2016, JACC. Cardiovascular imaging.

[9]  Volkmar Falk,et al.  2018 ESC/EACTS Guidelines on myocardial revascularization. , 2018, European heart journal.

[10]  Theresa M. Beckie,et al.  2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. , 2021, Circulation.

[11]  Seung‐Jung Park,et al.  Intravascular ultrasound-derived minimal lumen area criteria for functionally significant left main coronary artery stenosis. , 2014, JACC. Cardiovascular interventions.

[12]  T. Holland-Letz,et al.  How good are experienced interventional cardiologists at predicting the functional significance of intermediate or equivocal left main coronary artery stenoses? , 2007, International journal of cardiology.

[13]  Volker Klauss,et al.  Fractional flow reserve versus angiography for guidance of PCI in patients with multivessel coronary artery disease (FAME): 5-year follow-up of a randomised controlled trial , 2015, The Lancet.

[14]  R Waksman,et al.  Intravascular ultrasound assessment of the stenoses location and morphology in the left main coronary artery in relation to anatomic left main length. , 2001, The American journal of cardiology.

[15]  E. Edelman,et al.  Role of endothelial shear stress in the natural history of coronary atherosclerosis and vascular remodeling: molecular, cellular, and vascular behavior. , 2007, Journal of the American College of Cardiology.

[16]  J. Murray,et al.  ACC/AHA guidelines for coronary angiography. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Coronary Angiography). Developed in collaboration with the Society for Cardiac Angiography and Interventions. , 1999, Journal of the American College of Cardiology.

[17]  D. Berman,et al.  Long term prognostic utility of coronary CT angiography in patients with no modifiable coronary artery disease risk factors: Results from the 5 year follow-up of the CONFIRM International Multicenter Registry. , 2016, Journal of cardiovascular computed tomography.

[18]  M. J. Conley,et al.  The Prognostic Spectrum of Left Main Stenosis , 1978, Circulation.

[19]  W. Ghali,et al.  The prognostic importance of nonsignificant left main coronary artery disease in patients undergoing percutaneous coronary intervention. , 2006, Journal of the American College of Cardiology.

[20]  M. Budoff,et al.  Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Indi , 2008, Journal of the American College of Cardiology.

[21]  D. Berman,et al.  Prevalence and severity of coronary artery disease and adverse events among symptomatic patients with coronary artery calcification scores of zero undergoing coronary computed tomography angiography: results from the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International , 2011, Journal of the American College of Cardiology.

[22]  Young-Hak Kim,et al.  Impact of Intravascular Ultrasound Guidance on Long-Term Mortality in Stenting for Unprotected Left Main Coronary Artery Stenosis , 2009, Circulation. Cardiovascular interventions.

[23]  D. Newby,et al.  The Updated NICE Guidelines: Cardiac CT as the First-Line Test for Coronary Artery Disease , 2017, Current Cardiovascular Imaging Reports.

[24]  E. Bolson,et al.  Lumen Diameter of Normal Human Coronary Arteries: Influence of Age, Sex, Anatomic Variation, and Left Ventricular Hypertrophy or Dilation , 1992, Circulation.

[25]  Jeroen J. Bax,et al.  Impact of Non-obstructive left main disease on the progression of coronary artery disease: A PARADIGM substudy. , 2018, Journal of cardiovascular computed tomography.

[26]  A. Dunning,et al.  Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Results from the prospective multicenter DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study. , 2011, Journal of the American College of Cardiology.

[27]  G. Faggian,et al.  Physiologic evaluation of coronary lesions using instantaneous wave-free ratio (iFR) in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation. , 2018, EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology.

[28]  Mouaz Al-Mallah,et al.  Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings results from the International Multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) of 23,854 patients without know , 2011, Journal of the American College of Cardiology.

[29]  D. Andreini,et al.  Coronary computed tomography angiography for heart team decision-making in multivessel coronary artery disease , 2018, European heart journal.

[30]  J. Rumberger,et al.  Quantification of coronary artery calcium by electron beam computed tomography for determination of severity of angiographic coronary artery disease in younger patients. , 1995, Journal of the American College of Cardiology.

[31]  D. Berman,et al.  Prognostic Significance of Nonobstructive Left Main Coronary Artery Disease in Women Versus Men: Long-Term Outcomes From the CONFIRM (Coronary CT Angiography Evaluation For Clinical Outcomes An International Multicenter) Registry , 2017, Circulation. Cardiovascular imaging.

[32]  L D Fisher,et al.  Reproducibility of coronary arteriographic reading in the coronary artery surgery study (CASS). , 1982, Catheterization and cardiovascular diagnosis.

[33]  J. Herrick.  CLINICAL FEATURES OF SUDDEN OBSTRUCTION OF THE CORONARY ARTERIES , 1912 .

[34]  Hiroshi Ito,et al.  Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: the NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). , 2014, Journal of the American College of Cardiology.

[35]  S. Meyers,et al.  Angiographically silent left main disease detected by intravascular ultrasound: a marker for future adverse cardiac events. , 2003, American heart journal.

[36]  E. Hess,et al.  2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. , 2021, Journal of the American College of Cardiology.

[37]  S. Yusuf,et al.  Revascularization for unprotected left main stem coronary artery stenosis stenting or surgery. , 2008, Journal of the American College of Cardiology.

[38]  W. Hort,et al.  Quantitative study on the size of coronary artery supplying areas postmortem. , 1977, American heart journal.

[39]  Y. Arad,et al.  Objectives Background Methods Results Conclusions , 2022 .

[40]  Y. Arad,et al.  Prediction of coronary events with electron beam computed tomography. , 2000, Journal of the American College of Cardiology.

[41]  D. Andreini,et al.  Impact of Fractional Flow Reserve Derived From Coronary Computed Tomography Angiography on Heart Team Treatment Decision-Making in Patients With Multivessel Coronary Artery Disease: Insights From the SYNTAX III REVOLUTION Trial. , 2019, Circulation. Cardiovascular interventions.

[42]  P. Jüni,et al.  Five‐Year Outcomes with PCI Guided by Fractional Flow Reserve , 2018, The New England journal of medicine.

[43]  B. De Bruyne,et al.  The impact of downstream coronary stenosis on fractional flow reserve assessment of intermediate left main coronary artery disease: human validation. , 2015, JACC. Cardiovascular interventions.

[44]  W. Roberts,et al.  Accuracy of Angiographic Determination of Left Main Coronary Arterial Narrowing: Angiographic‐Histologic Correlative Analysis in 28 Patients , 1981, Circulation.

[45]  M. Vanderheyden,et al.  Long-Term Clinical Outcome After Fractional Flow Reserve–Guided Treatment in Patients With Angiographically Equivocal Left Main Coronary Artery Stenosis , 2009, Circulation.

[46]  C. Tommaso,et al.  Left main coronary artery disease: assessment, diagnosis, and therapy. , 1995, American heart journal.

[47]  D. Berman,et al.  Age-related risk of major adverse cardiac event risk and coronary artery disease extent and severity by coronary CT angiography: results from 15 187 patients from the International Multisite CONFIRM Study. , 2014, European heart journal cardiovascular Imaging.

[48]  H. Bøtker,et al.  Coronary CT angiography derived FFR in patients with left main disease , 2021, The International Journal of Cardiovascular Imaging.

[49]  M. Budoff,et al.  Prognostic value of number and site of calcified coronary lesions compared with the total score. , 2008, JACC. Cardiovascular imaging.

[50]  P. Stella,et al.  Deferral vs. performance of percutaneous coronary intervention of functionally non-significant coronary stenosis: 15-year follow-up of the DEFER trial. , 2015, European heart journal.