Original Investigation
Left Main Coronary Artery Compression in Patients With Pulmonary Arterial Hypertension and Angina

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Abstract

Background

Left main coronary artery (LMCA) compression is increasingly recognized as a cause of angina in pulmonary arterial hypertension (PAH).

Objectives

This study aimed to evaluate the prevalence of LMCA extrinsic compression from a dilated pulmonary artery (PA) in patients with PAH and angina or angina-like symptoms, determine the usefulness of screening with computed tomography coronary angiography (CTCA), and assess the safety and efficacy of percutaneous coronary interventions (PCIs).

Methods

All patients with PAH and angina or angina-like symptoms attending the center between May 1, 2008, and December 31, 2013, underwent CTCA. Patients with confirmed LMCA stenosis on selective coronary angiography had PCI.

Results

Of 765 patients with PAH, 121 had angina or angina-like symptoms. Ninety-four patients had abnormal CTCA based on the relationship between the PA and the LMCA and underwent selective coronary angiography. LMCA stenosis ≥50% was detected in 48 of the 94 patients. Forty-five patients underwent PCI with stenting, of whom 41 had sustained angina symptom relief. The 3 other patients had surgical PA reduction plasty. Nine months after PCI, 5 patients had LMCA restenosis and PCI was successfully repeated. The best predictor of LMCA stenosis ≥50% was a PA diameter ≥40 mm. Rates for death or double-lung transplant and the composite rates for death, double-lung transplant, or restenosis at 36 months were 5% and 30%, respectively.

Conclusions

The prevalence of LMCA compression in patients with PAH and angina is high. These results suggest that CTCA is indicated in patients with PAH and angina or angina-like symptoms. PCI was well tolerated, improved symptoms, and resulted in favorable long-term outcomes.

Key Words

computed tomography coronary angiography
percutaneous coronary interventions
pulmonary artery
stenosis

Abbreviations and Acronyms

BARC
Bleeding Academic Research Consortium
BMS
bare-metal stent(s)
CI
confidence interval
CTCA
computed tomography coronary angiography
DES
drug-eluting stent(s)
LMCA
left main coronary artery
MI
myocardial infarction
PA
pulmonary artery
PAH
pulmonary arterial hypertension
PCI
percutaneous coronary intervention
QCA
quantitative coronary analysis
ROC
receiver-operating characteristic
SCA
selective coronary angiography

Cited by (0)

This work was supported by the Department of Investigational, Diagnostic and Specialty Medicine, University of Bologna (Bologna, Italy) and the National Institute of Biostructures and Biosystems (Rome, Italy). The study sponsor/funder had no role in the design and conduct of the study; collection, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Editorial support was provided by Lynda McEvoy, PhD (ApotheCom Ltd., London, United Kingdom) funded by Actelion Pharmaceuticals Ltd. Dr. Saia has received personal fees from Abbott Vascular, Eli Lilly, AstraZeneca, Boston Scientific, Medtronic Inc., The Medicines Company, and St. Jude Medical, outside the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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