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Bifurcation functional significance score as predictor of mortality: a validating study
Dobrin Vassilev1, Niya Mileva2,3, Carlos Collet4
1Cardiology Department, Medical University Sofia, "Alexandrovska" University Hospital, Sofia, Bulgaria. dobrinv@gmail.com.
Scientific Reports
|December 22, 2021
Summary
A new Bifurcation Functional Significance Score (BFSS) helps assess coronary stenosis. A BFSS of 6.0 or higher predicts increased mortality risk in patients with coronary bifurcation lesions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Coronary bifurcation stenosis treatment has advanced, but anatomical assessment alone doesn't predict functional significance.
- Existing methods lack systematic evaluation of baseline functional significance and its impact on outcomes.
- Functional assessment is crucial for managing complex coronary artery disease.
Purpose of the Study:
- To develop and validate an angiographic score to determine the functional significance of coronary bifurcation stenosis.
- To assess the correlation between the developed score and procedural/clinical outcomes, including mortality.
- To investigate the impact of side branch territory size on mortality risk.
Main Methods:
- Patients with significant angiographic bifurcation lesions were included (diameter stenosis >50%).
- Fractional Flow Reserve (FFR) was measured in the main vessel (MV) and side branch (SB) before and after percutaneous coronary intervention (PCI).
- A Bifurcation Functional Significance Score (BFSS) was developed using parameters like SYNTAX score, BARI score, and degree of stenosis in MV and SB, and lesion length. The score was validated in derivation and clinical effect cohorts.
Main Results:
- A BFSS was developed with a maximum value of 11. A cut-off value of 6.0 demonstrated high discriminatory ability (87% accuracy, 77% sensitivity, 96% specificity).
- Patients with BFSS ≥ 6.0 showed significantly higher all-cause mortality (25.5% vs. 18.4%, p=0.001) and cardiac mortality (17.7% vs. 14.5%, p=0.016) compared to those with BFSS < 6.0.
- Smaller absolute side branch territory was associated with significantly lower cardiac mortality (p=0.023).
Conclusions:
- An angiographic score (BFSS) effectively determines the functional significance of coronary bifurcation stenosis.
- A BFSS ≥ 6.0 identifies patients at higher risk of all-cause and cardiac mortality.
- Smaller side branches represent a greater mortality risk in coronary bifurcation lesions.
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