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Predictors of functionally significant jailed side branch lesions |
서울대학교 병원¹, 계명대학교 병원², 연세대학교 병원³, 성균관대학교 삼성병원⁴, 아주대학교 병원5, 서울시립 보라매병원6, 서울대학교 분당병원7, 의료보험공단일산병원8, Stanford University Medical Center9 |
구본권¹, 강현재1, 김효수1, 남창욱2, 허승호2, 김중선3, 최동훈3, 장양수3, 한주용4, 권현철4, 윤명호5, 탁승제5, 정우영6, 조영석7, 최동주7, 오성진8, Peter J Fitzgerald9, William F Fearon9 |
Backgrounds: The predictor of functionally significant side branch (SB) stenosis after main branch (MB) stent implantation in bifurcation lesions is not well-known. We sought to identify the predictors of functionally significant SB jailing using anatomical and physiologic evaluations.
Methods: Seventy seven patients with de novo bifurcation lesions who underwent provisional SB intervention were prospectively enrolled from 8 Korea, Japan and US centers. MB IVUS was performed before MB stent implantation and fractional flow reserve (FFR) was measured in the jailed SB.
Results: The mean FFR was 0.71±0.20 and 29 lesions (43%) were functionally significant. FFR was <0.75 in 18 out of 33 lesions (54.5%) with >75% diameter stenosis. Among pre-invervention angiographic and IVUS parameters, SB minimal lumen diameter (r=0.48, p<0.0001), SB percent stenosis (r=-0.47, p<0.0001), SB minimal lumen area (r=0.47, p=0.01), lumen volume index of distal MB (r=-0.35, p=0.02) and plaque volume index of proximal MB (r=-0.30, p=0.05) correlated with SB FFR. Binary logistic regression analysis revealed that pre-intervention % diameter stenosis of SB (OR= 1.05, 95% CI: 1.01-1.09) and MB minimum lumen diameter located at the distal to SB ostium (OR =3.86, 95% CI: 1.03-14.43) were predictors of functionally significant SB jailing (FFR<0.75). In patients with >75% stenosis and TIMI 3 flow in the SB, no difference in angiographic or IVUS parameters was found between SB lesions with and without functional significance.
Conclusions: Anatomic evaluation does not reliably predict the functional significance of a jailed SB stenosis.
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Table. Pre-interventional angiographic predictors of functionally significant side branch stenosis after main branch stent implantation
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Odds ratio |
95% CI |
P value |
Main branch reference diameter |
1.1 |
0.3-4.2 |
0.89 |
Main branch % diameter stenosis |
1.0 |
1.0-1.1 |
0.99 |
Main branch lesion length |
1.0 |
1.0-1.1 |
0.50 |
Side branch reference diameter |
0.3 |
0.1-1.3 |
0.11 |
Side branch % diameter stenosis |
1.1 |
1.0-1.1 |
0.01 |
Side branch lesion length |
1.1 |
0.9-1.3 |
0.53 |
Bifurcation angle (>70) |
3.6 |
0.2-58.1 |
0.37 |
MLD location (distal vs. proximal) |
3.9 |
1.0-14.4 |
0.05 | CI: confidence interval; MLD: minimal lumen diameter
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