Identification of Coronary Artery Side Branch Supplying Myocardial Mass That May Benefit From Revascularization
- Hyung Yoon Kim; Joon-Hyung Doh; Hong-Seok Lim; Chang-Wook Nam; Eun-Seok Shin; Bon-Kwon Koo; Joo Myung Lee; Taek Kyu Park; Jeong Hoon Yang; Young Bin Song; Joo-Yong Hahn; Seung Hyuk Choi; Hyeon-Cheol Gwon; Sang-Hoon Lee; Sung Mok Kim; Yeonhyeon Choe; Jin-Ho Choi
- Dept. of Internal Medicine (내과학)
- Issue Date
- JACC. Cardiovascular Interventions, Vol.10(6) : 571-581, 2017
- OBJECTIVES The authors sought to identify whether a coronary side branch (SB) is supplying a myocardial mass that
may benefit from revascularization.
BACKGROUND The amount of subtending myocardium and physiological stenosis is frequently different between the
main vessel (MV) and SB.
METHODS In this multicenter registry, 482 patients who underwent coronary computed tomography angiography
and fractional flow reserve (FFR) measurement were enrolled. The % fractional myocardial mass (FMM), the ratio of
vessel-specific myocardial mass to whole myocardium, was assessed in 5,860 MV or SB consisting of 2,930 bifurcations.
Physiological stenosis was defined by fractional flow reserve (FFR) <0.80. Myocardial mass that may benefit from
revascularization was defined by %FMM $10%.
RESULTS In per-bifurcation analysis, MV supplied a 1.5- to 9-fold larger myocardial mass compared with SB. Unlike
left main bifurcation (n ¼ 482), only 1 of every 5 non-left main SB (n ¼ 2,448) supplied %FMM $10% (97% vs. 21%;
p < 0.001). SB length $73 mm could estimate %FMM $10% (c-statistic ¼ 0.85; p < 0.001). In 604 vessels interrogated
by FFR, diameter stenosis was similar (p ¼ 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 ¼ NS), but SB length $73 mm and left main bifurcation
were significant predictors for %FMM $10% (p < 0.001).
CONCLUSIONS Compared with MV, SB supplies a smaller myocardial mass and showed less physiological
severity despite similar stenosis severity. SB supplying a 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.
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- 1. Journal Papers (연구논문) > 1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
- Keimyung Author(s)
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