Author + information
- Hyung Yoon Kim1,
- Joon-Hyung Doh2,
- Hong-Seok Lim3,
- Chang-Wook Nam4,
- Eun-Seok Shin5,
- Bon-Kwon Koo6,
- Joo Myung Lee7,
- Taek Kyu Park7,
- Jeong Hoon Yang7,
- Young Bin Song7,
- Joo-Yong Hahn7,
- Seung Hyuk Choi7,
- Hyeon-Cheol Gwon7,
- Yeon Hyeon Choe7 and
- Jin-Ho Choi7
- 1Jeju National University Hospital, Korea (Republic of)
- 2Inje University Ilsan Paik Hospital, Korea (Republic of)
- 3Ajou University Hospital, Korea (Republic of)
- 4Keimyung University Dongsan Medical Center, Korea (Republic of)
- 5Ulsan University Hospital, Korea (Republic of)
- 6Seoul National University Hospital, Korea (Republic of)
- 7Samsung Medical Center, Korea (Republic of)
The amount of subtending myocardium and physiological stenosis is frequently different between MV and SB. To identify coronary Side Branch (SB) supplying myocardial masswhich may benefit from revascularization.
In this multi-center registry, 482 patients who underwent coronary CT angiography and Fractional Flow Reserve (FFR) measurement were enrolled. % Fractional Myocardial Mass (FMM), a fraction of Vessel-specific myocardial mass to the whole myocardium, was assessed in 5,860 MV or SB consisting 2,930 bifurcations. Physiological stenosis was defined by Fractional Flow Reserve (FFR) <0.80. Myocardial mass which may benefit from revascularization was defined by %FMM≥10%.
In the per-bifurcation analysis, MV supplied 1.5- to 9-fold larger myocardial mass compared with SB. Unlike left main bifurcation (N=482), only one out of every five non-left main SB (N=2,448) supplied %FMM≥10% (97% versus 21%, p<0.001). SB length≥73 mm could estimate %FMM≥10% (c-statistics=0.85, p<0.001). In 604 vessels interrogated by FFR, diameter stenosis was similar (p=NS) but %FMM≥10%, FMM/minimal luminal diameter, and frequency of FFR<0.80 was higher in MV compared with SB (p<0.001, all). Generalized estimating equations modeling demonstrate that vessel diameter, left myocardial mass, and FFR were not (p=NS) but SB length≥73 mm and left the main bifurcation were significant predictors for %FMM≥10% (p<0.001).
Compared with MV, SB supplies smaller myocardial mass and showed less physiological severity despite similar stenosis severity. SB supplying the myocardial mass of %FMM≥10% which may benefit revascularization could be identified by vessel length≥73 mm. Pre-procedural recognition of these findings may guide optimal revascularization strategy for bifurcation.