The DEFINE-LM registry showed that patients with chronic coronary syndromes (CCS) diagnosed with significant stenosis of the left main (LM) by iFR had better long-term clinical outcomes if they underwent PCI or CABG compared with those who underwent deferred revascularization, according to a study published in collaboration with the Gifu Heart Center, St. Marianna University School of Medicine, and Imperial College London. The study was presented by Dr. Takayuki Warisawa, Imperial College London, at the Interventional and Structural Moderated Poster Session at ACC 22.
Medical Therapy Vs. Revascularization for LM Disease with Proven Ischemia: From the DEFINE-LM Registry
The DEFINE-LM registry enrolled 446 patients with stable LM disease with 40-70% stenosis in the unprotected LM and measured iFR from 10 centers in Europe, USA, and Japan. The study included 225 CCS patients with LM disease with significant stenosis with iFR ≤0.89 included in the DEFINE-LM registry. In 74 pairs of propensity score matching, the clinical outcomes were compared between the 74 patients who were deferred and 74 out of the 151 patients who underwent revascularization.
The mean age of the patients was 68.5 years, and 78.2% were male. The mean SYNTAX score was 22.1. Those with LM disease only amounted to 10%, while 24% had LM + 1-vessel disease, 39% had LM + 2-vessel disease, and 27% had LM + 3-vessel disease. The iFR median was 0.83. In the revascularization group, 44 patients underwent PCI and 30 underwent CABG.
At a median follow-up of 2.8 years, the rates of the primary endpoints (all-cause mortality, nonfatal MI, and TLR of ischemic origin of LM) were significantly different, with 29.7% in the defer group and 14.9% in the revascularization group (HR 2.41 [95%CI 1.13-5.13] p=0.023). The rate of cardiac death/spontaneous MI related to LM was numerically higher in the deferred group (8.1%) and in the revascularization group (1.4%), but not statistically significant (HR 7.87 [95%CI 0.94-66.2] p=0.058). LM-driven TLR however was significantly higher in the deferred group (17.6% vs 5.4%: HR 5.03 [95%CI 1.43-17.7] p=0.012).
Dr. Warisawa summarized, “In CCS patients with physiologically significant LM disease by iFR, patients who underwent revascularization showed significantly improved long-term clinical outcomes compared to those who were deferred.”
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