Main Article Content
To compare the efficacy of two treatment strategies, Fraction Flow Reserve (FFR) guided coronary intervention and the conventional method (angiographic guided only) in treating jailed side branch in patients with coronary bifurcation disease. Efficacy will be determined by clinical outcomes (cardiac death, myocardial infarction (MI), target vessel revascularization (TVR) at the 6 months follow-up.
MATERIAL AND METHODS:
This prospective analytic design study included a total of 26 patients with de novo, coronary bifurcation disease with significant side branch lesions after successful drug eluting stent implantation of the main branch. All patients were recruited between June and December 2011 from Bangkok Metropolitan Administrative Medical College and Vajira Hospital. After main branch stenting we 2:1 randomly assigned patients to undergo side branch intervention guided by angiography alone or FFR measurement. The FFR-guided group only received side branch intervention if the FFR was 0.75 or less.
Of the 26 patients, 8 were randomly assigned to FFR guided PCI and 18 to the conventional (CI) group. The baseline characteristics of the two groups were similar. Similarly, there was no significant difference in the baseline angiographic profiles and procedural characteristics between these two groups. Among the FFR group, 3 patients (37.5%) still had FFR < 0.75 after side-branch kissing balloon so side-branch stenting was performed with provisional T-stent technique in all three patients. In the CI group, 11 patents (61.11%) had side branch stenting with two (18.18%) in culotte technique, four (36.36%) in T stent technique and five (45.46%) in crush technique. At 6 months, one of eighteen patients (5.50%) in the CI group died from frank pulmonary edema and cardiogenic shock. None of the FFR group died during this period. Two (11.10%) in the CI group had target vessel revascularization from side branch in-stent restenosis. There was no statistical difference in major cardiovascular events (cardiac death, MI, TVR) between the two groups during the 6 month follow-up period (p = 0.08). CONCLUSION: FFR guided coronary intervention in patients with bifurcation lesion may reduce mortality and target vessel revascularization at 6 months and may be considered as a reasonable optional technique.
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2. Pan M, de Lezo JS, Medina A, et al. Rapamycin-eluting stents for the treatment of bifurcated coronary lesions: A randomized comparison of a simple versus complex strategy. Am Heart J 2004;148:857-64.
3. Ge L, Tsagalou E, Iakovou I, et al. In-hopital and nine- month outcome of treatment of coronary bifurcational lesions with sirolimus-eluting stent. Am J Cardiol 2005; 95:757-60.
4. Steigin TK, Maeng M, Wiseth R, et al Nordic PCI study group. Randomized study on simple versus complex stenting of coronary artery bifurcation lesions. The Nordic bifurcation study. Circulation 2006;114:1955-61.
5. Tanabe K, Hoye A, Lemos PA, et al. Restenosis rates following bifurcation stenting with sirolimus-eluting stents for de novo narrowings. Am J Cardiol 2004;91:115-8.
6. Ge L, Iakovou I, Cosgrave J, et al. Treatment of bifurcation lesions with two stents: one year angiographic and clinical follow up of crush versus T stenting. Heart 2006;92:371-6.
7. Lefevre T, Louvard Y, Morice MC, et al. Stenting of bifurcation lesions: classification, treatments, and results. Cath eter Cardiovasc Interv 2000;49:274-83.
8. Yamashita T, Nishida T, Adamian MG, et al. Bifurcation lesions: two stents versus one stent-immediate and follow-up results. J Am Coll Cardiol 2000;35:1145-51.
9. Al Suwaidi J, Berger PB, Rihal CS, et al. Immediate and long-term outcomes of intracoronary stent implantation for true bifurcation lesions. J Am Coll Cardiol 2000; 35:1145-51.
10. Bech GJ, Droste H, Pijls NH, et al. Value of fractional flow reserve in making decisions about bypass surgery for equivocal left main coronary artery disease. Heart 2001;86:547-52.
11. Ziaee A, Parham WA, Hermann SC, et al. Lack of relation between imaging and physiology in ostial coronary artery narrowings. Am J Cardiol 2004;93:1404-7.
12. Koo BK, Kang HJ, Youn TJ, et al. Physiologic assessment of jailed side -branch lesions using fractional flow reserve. J Am Coll Cardiol 2005;46:633-7.
13. Pijls NH, van Schaardenburgh P, Manoharan G, et al. Percutaneous coronary intervention of functionally non-significant stenosis: 5 year follow-up of the DEFER Study. J Am Coll Cardiol 2007:49:2105-11.