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European Heart Journal Advance Access originally published online on February 28, 2008
European Heart Journal 2008 29(6):726-732; doi:10.1093/eurheartj/ehn045
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Physiological evaluation of the provisional side-branch intervention strategy for bifurcation lesions using fractional flow reserve

Bon-Kwon Koo1, Kyung-Woo Park1, Hyun-Jae Kang1, Young-Seok Cho2, Woo-Young Chung2, Tae-Jin Youn2, In-Ho Chae2, Dong-Ju Choi2, Seung-Jae Tahk3, Byung-Hee Oh1, Young-Bae Park1 and Hyo-Soo Kim1,*

1 Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center and Cardiovascular Research Institute, Seoul National University Hospital, Yongon-dong 28, Jongno-gu, Seoul 110-744, Republic of Korea
2 Heart Center, Bundang Seoul National University Hospital, Gyeonggi-do, Republic of Korea
3 Ajou University School of Medicine, Gyeonggi-do, Republic of Korea

Received 26 March 2007; revised 8 January 2008; accepted 17 January 2008; online publish-ahead-of-print 28 February 2008.

* Corresponding author. Tel: +82 2 2072 2226, fax: +82 2 766 8904, Email: hyosoo{at}snu.ac.kr

See page 704 for the editorial comment on this article (doi:10.1093/eurheartj/ehn054)

Aims: This study was performed to evaluate the functional outcomes of fractional flow reserve (FFR)-guided jailed side-branch (SB) intervention strategy.

Methods and results: One hundred and ten patients treated by provisional strategy were consecutively enrolled and SB FFR was measured in 91 patients. SB intervention was allowed when FFR was <0.75. FFR measurement was repeated after SB intervention and at 6-month follow-up angiography. In 26 of 28 SB lesions with FFR <0.75, balloon angioplasty (SB balloon/artery ratio = 0.84 ± 0.14) was performed and FFR ≥0.75 was achieved in 92% of the lesions although the mean residual stenosis was 69 ± 10%. During follow-up, there were no changes in SB FFR in lesions with (0.86 ± 0.05 to 0.84 ± 0.01, P = 0.4) and without SB angioplasty (0.87 ± 0.06 to 0.89 ± 0.07, P = 0.1). Functional restenosis (FFR <0.75) rate was only 8% (5/65). When clinical outcomes of these patients were compared with 110 patients with similar bifurcation lesions treated without FFR-guidance, there was no difference in 9-month cardiac event rates (4.6 vs. 3.7%, P = 0.7) between the two groups.

Conclusion: In conclusion, FFR-guided SB intervention strategy resulted in good functional outcomes.

Key Words: Bifurcation • Physiology • Stents • Angioplasty • Restenosis


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