LAUSR

Background: Rates of major adverse cardiac events (MACE) after functionally guided percutaneous coronary intervention (PCI) of coronary bifurcation lesions have not been specifically analysed. Methods: Patients from FIESTA registry (ClinicalTrials.govNCT01724957) with stable angina, bifurcation lesions in a coronary artery with diameter ≥ 2.5 mm and ≤ 4.5 mm and SB diameter≥2.0 mm were included in the analysis. Subjects with ST-segment elevation myocardial infarction, left main disease, hemodynamic instability were excluded. Provisional stenting was the default strategy in all patients. Fractional flow reserve (FFR) was performed using the PrimeWire or PrimeWire Prestige (Volcano Corp., USA). Bifurcation lesion with FFR above 0.80 were deferred from PCI. Follow-up for vital status at every 3-month period was performed and rates of MACE, including cardio-vascular death, nonfatal myocardial infarction and stroke, were analyzed. Results: Overall 165 patients were included, mean age was 67±10 years, 66% males, 72 (44%) had functionally significant bifurcation lesions (FSL) and 93 (56%) were with non-significant lesions (nFSL). There were no differences (FSL vs. nFSL) regarding: dyslipidemia (88% vs 96%), diabetes (44% vs. 32%), smoking (52% vs 40%), previous MI (24% vs 15%), previous PCI (54% vs 49%), atrial fibrillation (17% vs 29%), PAD (10% vs. 9%), renal failure (29% vs 31%) – all p>0.05. On a median follow-up of 34±14 months there were no differences between FSL and nFSL regarding rates of cardio-vascular death -12.5% (n=9/72) vs. 7.5% (n=7/93), p=0.4, MACEs - 13.9% (n=10/72)vs 8.6 (8/93), p=0.512. On multivariate Cox-regression analysis factors associated with occurrence of MACE were: presence of cancer OR 3.692, (CI 0.955-14.269); renal failure OR 2.550, (CI 0.961-6.767) SYNTAX ≥9 OR 1.836, (CI 0.490-6.874); SB RVD ≥ 2.4mm OR 2.546, (CI 0.708-9.160); SB BARI 13.5% OR 2.013, (CI 0.652-6.211); WBC≥7OR 3.647, (CI 0.824-16.134); Platelet count ≥ 256.106/ml OR 3.814, (CI 1.220-11.925). Conclusion: Less than a half of angiographically significant coronary bifurcation lesions were functionally significant requiring stent implantation. The rates of MACE were not-significantly different in deferred and treated stenoses up to 3 years follow-up.