scholarly journals Bifurcation functional significance score as predictor of mortality: a validating study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Dobrin Vassilev ◽  
Niya Mileva ◽  
Carlos Collet ◽  
Pavel Nikolov ◽  
Katerina Sokolova ◽  
...  
Keyword(s):  
Functional Significance ◽  
Side Branch ◽  
Lesion Length ◽  
Cardiac Mortality ◽  
Coronary Bifurcation ◽  
Discriminatory Ability ◽  
Derivation Cohort ◽  
Significance Score ◽  
Significant Difference ◽  
Main Vessel

AbstractConsiderable progress has been made in the treatment of coronary bifurcation stenosis. Anatomical characteristics of the vessel and lesion, however, fail to give information about the functional significance of the bifurcation stenosis. To the best of our knowledge, there is no study that systematically establishes the baseline functional significance of coronary stenosis and its effect on procedural and clinical outcomes. Patients with significant angiographic bifurcation lesions defined as diameter stenosis > 50% in main vessel and/or side branch were included. FFR was performed in main vessel (MV) and side branch (SB) before and after percutaneous coronary intervention (PCI). 169 patients from Fiesta study (derivation cohort) and 555 patients from prospective bifurcation registry (clinical effect cohort) were analyzed to validate angiographic prediction score (BFSS) used to determine the potentially functional significance of coronary bifurcation stenosis. Bifurcation functional significance score (including the following parameters—SYNTAX ≥ 11, SB/MB BARI score, MV %DS ≥ 55%, main branch (MB) %DS ≥ 65%, lesion length ≥ 25 mm) with a maximum value of 11 was developed. A cut-off value of 6.0 was shown to give the best discriminatory ability—with accuracy 87% (sensitivity 77%, specificity 96%, p < 0.001). There was also a significant difference in all-cause mortality between patients with BFSS ≥ 6.0 vs. BFSS < 6.0–25.5% vs. 18.4%, log-rank p = 0.001 as well as cardiac mortality: BFSS ≥ 6.0 vs. BFSS < 6.0–17.7% vs. 14.5%, log-rank (p = 0.016). The cardiac mortality was significantly lower in patients with smaller absolute SB territory, p = 0.023. An angiographic score (BFSS) with good discriminatory ability to determine the functional significance of coronary bifurcation stenosis was developed. The value for BFSS ≥ 6.0 can be used as a discriminator to define groups with higher risk for all-cause and cardiac mortality. Also, we found that the smaller side branches pose greater mortality risk.

scholarly journals Bifurcation Functional Significance Score as Predictor of Mortality

2021 ◽  
Author(s):  
Dobrin Vassilev ◽  
Niya Mileva ◽  
Carlos Collet ◽  
Pavel Nikolov ◽  
Katerina Sokolova ◽  
...  
Keyword(s):  
Functional Significance ◽  
Side Branch ◽  
Lesion Length ◽  
Cardiac Mortality ◽  
Coronary Bifurcation ◽  
Discriminatory Ability ◽  
Derivation Cohort ◽  
Significance Score ◽  
Significant Difference ◽  
Main Vessel

Abstract Background: Considerable progress has been made in the treatment of coronary bifurcation stenosis. Anatomical characteristics of the vessel and lesion, however, fail to give information about the functional significance of the bifurcation stenosis. To the best of our knowledge, there is no study that systematically establishes the baseline functional significance of coronary stenosis and its effect on procedural and clinical outcomes.Methods: Patients with significant angiographic bifurcation lesions defined as diameter stenosis > 50% in main vessel and/or side branch were included. FFR was performed in main vessel (MV) and side branch (SB) before and after percutaneous coronary intervention (PCI). 169 patients from Fiesta study (derivation cohort) and 555 patients from prospective bifurcation registry (test cohort) were analyzed to validate angiographic prediction score (BFSS) used to determine the potentially functional significance of coronary bifurcation stenosis.Results: Bifurcation functional significance score (including the following parameters - SYNTAX ≥11, SB/MB BARI score, MV %DS ≥ 55%, MB %DS ≥ 65%, lesion length ≥25mm) with a maximum value of 11 was developed. A cut-off value of 8.5 was shown to give the best discriminatory ability – with accuracy 87% (sensitivity 77%, specificity 96%, p<.001). There was also a significant difference in all-cause mortality between patients with BFSS≥8.5 vs. BFSS<8.5 – 17.8% vs. 13.4%, log-rank p=.006, as well as cardiac mortality: BFSS≥8.5 vs. BFSS<8.5 – 14.6% vs. 12.5%, log-rank (p=.042). The cardiac mortality was significantly lower in patients with smaller absolute SB territory, p=0.023.Conclusion: An angiographic score (BFSS) with good discriminatory ability to determine the functional significance of coronary bifurcation stenosis was developed. The value for BFSS≥8.5 can be used as a discriminator to define groups with higher risk for all-cause and cardiac mortality. Also, we found that the smaller side branches pose greater mortality risk.

Side branch long lesion with main vessel vulnerable plaques by optical coherence tomography predict target-vessel myocardial infarction after provisional stenting in patients with coronary bifurcation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S.L Chen
Keyword(s):  
Side Branch ◽  
Lesion Group ◽  
Lesion Length ◽  
Coronary Bifurcation ◽  
Coronary Bifurcation Lesions ◽  
Vulnerable Plaques ◽  
Main Vessel ◽  
Bifurcation Lesions ◽  
Provisional Stenting ◽  
One Year

Abstract Background Provisional side branch (SB) stenting is correlated with target-vessel myocardial infarction (TVMI) in patients with coronary bifurcation lesions. However, the underlying mechanisms remain unknown. Objectives We aimed to determine the correlation of SB lesion length with vulnerable plaques using optical coherence tomography (OCT) and TVMI in patients with coronary bifurcation lesions treated by a provisional approach. Methods A total of 405 patients with 405 bifurcation lesions who underwent pre-PCI OCT imaging of both main vessel (MV) and SB was prospectively enrolled. Patients were defined as Long-SB lesion (SB lesion length ≥10 mm) and Short-SB lesion (SB lesion length &lt;10 mm) groups according to quantitative coronary analysis and were also stratified by the presence of vulnerable plaques based on OCT findings. The primary endpoint was the occurrence of TVMI after provisional stenting at one-year follow-up. Results 178 (43.9%) patients had long SB lesions. Vulnerable plaques predominantly localized in the main vessel (MV) and more frequently in the Long-SB lesion group (42.7%) compared to 24.2% in the Short-SB lesion group (p&lt;0.001). At one-year follow-up after provisional stenting, there were 31 (8.1%) TVMIs, with 11.8% in the Long-SB lesion group and 4.4% in the Short-SB lesion group (p=0.009), leading to significant difference in target lesion failure between two groups (15.2% vs. 6.6%, p=0.007). The rate of cardiac death, revascularization, and stent thrombosis was comparable between study groups. By multivariate regression analysis, long SB lesion length (p=0.011), presence of vulnerable plaques in the polygon of confluence (p=0.001), and true coronary bifurcation lesions (p=0.004) were three independent factors of TVMI. Conclusions Long-SB lesion length with MV vulnerable plaques predict increased TVMI after provisional stenting in patients with true coronary bifurcation lesions. Further study is warranted to identify the better stenting techniques for coronary bifurcation lesions with long lesion in the SB Kaplan-Meier survival curve Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): NSFC

Side branch FFR after provisional stenting: simplified approach based on OCT frame count

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Kini ◽  
N Okamoto ◽  
N Barman ◽  
Y Vengrenyuk ◽  
K Yasumura ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Functional Significance ◽  
Area Under The Curve ◽  
Side Branch ◽  
Funding Source ◽  
Fractional Flow ◽  
Simplified Approach ◽  
Main Vessel ◽  
Bifurcation Lesions ◽  
Provisional Stenting

Abstract Background/Introduction Treatment of bifurcation coronary artery lesions remains a major challenge in interventional cardiology. Side branch (SB) stenoses are frequently observed after stent implantation in bifurcation lesions, although angiographically narrowed SBs may not be functionally significant. Fractional flow reserve (FFR), a pressure-derived index of the hemodynamic significance of a coronary artery stenosis, may be useful in determining whether additional intervention is required in jailed SBs. Angiography and intravascular ultrasound (IVUS) derived parameters have showed poor diagnostic accuracy in predicting the functional significance of jailed SBs. Purpose The aim of the present study was to use high resolution optical coherence tomography (OCT) imaging to predict functionally significant SB stenoses after provisional stenting defined as SB FFR ≤0.80. Methods Seventy-one patients with 71 calcified bifurcation lesions with angiographically intermediate SB stenoses undergoing provisional stenting were enrolled in the prospective study. OCT pullbacks were performed before and after stent placement, and SB FFR was measured after main vessel stenting. SB ostium area (SBOA) was assessed using three-dimensional OCT cut-plane analysis off-line. In addition, we developed a simplified approach to SB ostium assessment based on SB ostium frame count using two-dimensional OCT pullback not requiring off-line 3D reconstruction. For the analysis, consecutive frames were counted between the most distal and most proximal take-off of the SB frames. Results Similar to previous studies, quantitative coronary angiography findings were not associated with the functional significance of SBs after main vessel stenting. In contrast, SBOA assessed by 3D-OCT after provisional stenting strongly correlated with post-procedure SB FFR. The optimal cut-off value for the SBOA area to predict a SB FFR ≤0.80 was 0.76 mm2 (sensitivity 82%, specificity 89% and area under the curve of 0.92 (95% CI: 0.84–0.99). A simplified approach to SB ostium assessment using OCT frame count yielded a sensitivity of 82%, specificity 89% and area under the curve 0.92 (95% CI: 0.84 to 0.99) with a cut-off of 4.5 frames allowing detection of functionally significant SB stenoses during the procedure in real time. Figure 1 shows a receiver-operating characteristic curve for SB FFR ≤0.8 and a representative case with SB FFR = 0.66 after provisional stenting and SB ostium frame count equal 3 (Frame 1 to 3) Conclusion(s) Assessment of SB using either 3D OCT off-line reconstruction or a simplified approach based on OCT frame count can detect SB branches with FFR ≤0.80 with high sensitivity and specificity. The developed approaches may represent a useful tool to assess provisional stent outcomes. Figure 1 Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Boston Scientific; St. Jude Medical

Ex vivo analysis of human coronary bifurcation anatomy: defining the main vessel-to-side-branch transition zone

2009 ◽  
Vol 5 (1) ◽  
pp. 96-103 ◽  
Author(s):  
Mary Russell ◽  
Gary Binyamin ◽  
Eitan Konstantino
Keyword(s):  
Transition Zone ◽  
Ex Vivo ◽  
Side Branch ◽  
Coronary Bifurcation ◽  
Main Vessel

scholarly journals TCT-475 Two-stent Strategies for Coronary Bifurcation Lesions: Main Vessel First Versus Side Branch First

2015 ◽  
Vol 66 (15) ◽  
pp. B194
Author(s):  
Taek Kyu Park ◽  
Jong-Hwa Ahn ◽  
Young Bin Song ◽  
Woo Jung Chun ◽  
Joo-Yong Hahn ◽  
...  
Keyword(s):  
Side Branch ◽  
Coronary Bifurcation ◽  
Coronary Bifurcation Lesions ◽  
Main Vessel ◽  
Bifurcation Lesions

scholarly journals Predictors and Outcomes of Side Branch Occlusion After Main Vessel Stenting in Coronary Bifurcation Lesions

2013 ◽  
Vol 62 (18) ◽  
pp. 1654-1659 ◽  
Author(s):  
Joo-Yong Hahn ◽  
Woo Jung Chun ◽  
Ji-Hwan Kim ◽  
Young Bin Song ◽  
Ju Hyeon Oh ◽  
...  
Keyword(s):  
Side Branch ◽  
Coronary Bifurcation ◽  
Coronary Bifurcation Lesions ◽  
Main Vessel ◽  
Bifurcation Lesions

scholarly journals Inflation Pressure in Side Branch during Modified Jailed Balloon Technique Does Not Affect Side Branch Outcomes

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Tetsuya Nomura ◽  
Naotoshi Wada ◽  
Issei Ota ◽  
Satoshi Tasaka ◽  
Kenshi Ono ◽  
...  
Keyword(s):  
Univariate Analysis ◽  
Coronary Intervention ◽  
Side Branch ◽  
Plaque Burden ◽  
Lesion Length ◽  
Inflation Pressure ◽  
Balloon Inflation ◽  
Stent Deployment ◽  
Main Vessel ◽  
Balloon Technique

Objectives. This study aimed to investigate the optimal jailed balloon inflation in the side branch during the modified jailed balloon technique for bifurcated lesions. Background. The modified jailed balloon technique is one of the effective techniques to minimize the emergence of side branch (SB) compromise by preventing plaque or carina shifting during a single stent strategy in the main vessel with provisional SB treatment. However, there are no detailed studies on the method of optimal jailed balloon inflation. Methods. We analyzed 51 consecutive patients who underwent percutaneous coronary intervention (PCI) for bifurcated lesions with a modified jailed balloon technique between September 2018 and December 2020. These 51 patients were divided into two groups according to the magnitude of inflation pressure of the jailed balloon: a higher pressure (HP) group and lower pressure (LP) group. Results. No significant differences in procedural outcomes were observed between the two groups. The findings of SB compromise were relatively common with our procedure (30.0% in the HP group; 33.3% in the LP group). The patterns of SB compromise such as dissection or stenosis increase were observed at similar frequencies between them. In particular, SB dissection was noted in the SB lesion with some plaque burden, irrespective of the magnitude of the jailed balloon inflation pressure. Univariate analysis showed that calcification in the main vessel and SB lesion length was significantly associated with SB compromise. Finally, all PCI procedures were successfully completed without any provisional stent deployment in SB. Conclusions. We speculate that lesion characteristics rather than the PCI procedural factors may be critical determinants to cause SB compromise.

P1963The determinants of functional significance of coronary bifurcation lesions and its implications on clinical follow up to 48 months (insights from FIESTA registry)

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Vassilev ◽  
P Nikolov ◽  
N Mileva ◽  
G Zlatancheva ◽  
G Dimitrov ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Functional Significance ◽  
Selection Strategy ◽  
Syntax Score ◽  
Coronary Bifurcation ◽  
Coronary Bifurcation Lesions ◽  
Co Morbidity ◽  
Main Vessel ◽  
Bifurcation Lesions

Abstract Background There is no study up-to-now to determine the rate of functionally significant coronary bifurcation lesions, which have to be intervened and what are the clinical consequences of the FFR case selection strategy. Methods We analyzed patients from FIESTA registry, which was continuation of FIESTA study (Ffr vs. IcEcgSTA, ClinicalTrials.gov Identifier: NCT01724957). Patients with stable angina were included (if there were other coronary stenoses they were threated first after checking by FFR for functional significance). The inclusion criterions were angiographic bifurcation lesions in a native coronary artery with diameter ≥2.5 mm and ≤4.5 mm and SB diameter ≥2.0 mm. We excluded patients with ST-segment elevation myocardial infarction, left main, hemodynamic instability and those with non-cardiac co-morbidity conditions with a life expectancy of less than one year. PCI was performed according to the current guidelines. Provisional stenting was the default strategy in all patients. Two guidewires were inserted into both distal MB and SB. Initial FFR was performed using the PrimeWire or PrimeWire Prestige (Volcano Corp., USA). For all FFR measurements, intracoronary adenosine was given in increasing doses of 60 mcg, 120 mcg, and 240 mcg. The minimum value of FFR measurements was taken for analysis. All patients received double antiplatelet therapy with ADP-antagonist and aspirin for at least 12 months. Results A 130 consecutive patients with coronary bifurcation stenoses were included – 57 had positive FFR<.80 in main vessel of bifurcation lesion (44% functionally significant lesions). The mean age was 67±10 years, 66% males, 96% hypertensive, 39% diabetic, 96% dyslipidemic (or on treatment with statin), 55% smokers, 22% with previous myocardial infarction, 51% with previous PCI. The residual SYNTAX score before FFR bifurcation assessment was 13±4 (FFR<.80) vs. 8±3 (FFR≥0.80), p<0.001. Univariate predictors of bifurcation FFR<.80 were: proximal (MV%DS) or distal (MB%DS) main vessel stenosis ≥85% (derived from ROC analysis with overall accuracy 77% and 72%, accordingly), lesion length, SYNTAX score, triglyceride concentration, previous MI on lateral wall and carotid artery disease. On multivariate logistic analysis only MV%DS>85% (OR=8.929, CI 2.887–27.619, p<0.001), MB%DS>85% (OR=3.831, CI 1.349–10.883, p=0.012) and SYNTAX score≥12 (OR=16.466, CI 5.225–15.889, p<0.001). At median follow-up of 26 months (IQR 17–35) the all-cause mortality was 17.5% in FFR positive bifurcations vs. 4.1% in FFR negative lesions (log-rank =.067). Conclusions Less than a half of angiographically significant coronary bifurcation lesions are functionally significant and require stent implantation. The functional significance was related with higher degree stenosis in main vessel and overall disease severity estimated with SYNTAX score. A trend to lower mortality was noted in group with non-significant FFRs.

Sign in / Sign up

Export Citation Format

Share Document