Retrospective Ananysis Of Treatment Of Side Branch After Main Vessel Stenting Using Fractional Flow Reserve

Objective: The study was performed to evaluate the outcomes of provisionalside-branch(SB) intervention strategy using fractional flow reserve (FFR) andconventional coronary angiography in coronary bifurcation lesion.Methods: Between January2010and January2012,85patients treated byprovisional strategy were consecutively enrolled. The clinical data, lesionscharacteristic, operation strategy, percutaneous coronary intervention (PCI) results,intraoperative and postoperative complications and major adverse cardiac events(MACE) were analyzed. These patients were divided into FFR group(35patients) andconventional group(50patients) according to whether intervention of SB was guidedby FFR. In two group patients, the operation time, the amount of contrast medium,MACE rates during hospitalization and1,6,12-month clinical follow-up andoutcomes of coronary angiography and FFR were compared.Results:1、In FFR group(35patients) and conventional group(50patients) SB stenosis>70%before kissing balloon inflation were13cases (37.1%) and21cases (42.0%).There was no significant difference between two groups(P=0.653, P>0.05). Mainbrach(MB) residual stenosis>30%were2cases(5.7%) and2cases (4.0%). Therewas no significant difference between two groups(P=1.0, P>0.05).2、In FFR group(35patients) and conventional group SB lesions with kissingballoon inflation were7cases(20.0%) and21cases(4.0%). SB lesion stent implantedwere0case(0%) and8cases(16%). SB residual stenosis>50%after operation were10cases(28.6%) and5cases(10.0%). There were significant differences between twogroups(kissing balloon inflation P=0.034, SB stenting P=0.027, SB residualstenosis>50%P=0.035, all P<0.05).3、In two groups(FFR group, conventional group) the operation time wererespectively1.30±0.32h and1.22±0.24h. When the operation time of FFR group werecompared with conventional group, there was no significant difference between twogroups(P>0.05). 4、The amounts of contrast medium were respectively110.18±16.91ml和119.71±19.92ml. When amounts of contrast medium of FFR group werecompared with conventional group, there was no significant differences betweentwo groups(P>0.05).5、In two groups the cases of slow flow after MB stenting were respectively3（8.6%）and4（8.0%）. The cases of MB TIMI（thrombolysis in myocardialinfarction） grade3flow were respectively35(100%) and50(100%). The cases of SBTIMI grade3flow were respectively33(94.3%) and47(94%). The cases of anginaafter operation were respectively4(11.4%) and6(12.0%). No death, no myocardialinfarction, no coronary artery bypass grafting（CABG）, no stent thrombosis, nocontrast induced nephropathy. When clinical complications of FFR group werecompared with conventional group, there was no significant difference between twogroups（P>0.05).6、During1,6,12-month follow-up, MACE of FFR group compared withconventional group, there was no significant difference between twogroups(P>0.05).7、There was no significant difference between postoperative FFR and FFR of6-month follow-up(P>0.05). There was a significant difference between SB FFRbefore kissing balloon inflation and SB FFR after kissing balloon inflation (P<0.05).There was no significant difference between SB FFR of SB after double ballon kissand SB FFR during6-month follow-up (P<0.05).8、In6-month follow-up angiography, the cases of MB TIMI flow3wererespectively35(100%) and50(100%). The cases of SB TIMI flow3wererespectively35(100%) and50(100%). The cases of MB residual stenosis>30%wererespectively3（8.6）and5(10%). There were no significant differences in two groups.（all P=1.0>0.05). The cases of SB residual stenosis>50%were respectively11(31.4%) and6(12%). When the outcome of FFR group compared withconventional group, there was a significant difference between two groups(P=0.028,P<0.05).Conclusions:1、FFR-guided intervention for bifurcation lesions was safe and feasible.2、Little balloons and stents were used in FFR-guided intervention.