Related Experiment Video
Updated: Jun 12, 2025
Optical Coherence Tomography Based Biomechanical Fluid-Structure Interaction Analysis of Coronary Atherosclerosis Progression
Published on: January 15, 2022
Impact of Bifurcation Lesions on Outcomes After FFR-Guided PCI or CABG
Daimy M M Dillen1, Hisao Otsuki2, Kuniaki Takahashi2
1Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands (D.M.M.D., K. Teeuwen, P.A.L.T., N.H.J.P., F.M.Z.).
Insights
The presence of coronary bifurcation lesions does not impact clinical outcomes for patients undergoing contemporary percutaneous coronary intervention (PCI) with drug-eluting stents or coronary artery bypass grafting (CABG). This finding holds true regardless of the revascularization strategy used.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Bifurcation lesions historically posed challenges for percutaneous coronary intervention (PCI), leading to poorer outcomes compared to coronary artery bypass grafting (CABG).
- Contemporary PCI strategies, including second-generation drug-eluting stents and fractional flow reserve (FFR) guidance, aim to improve outcomes in complex coronary artery disease.
- The FAME 3 trial provides a platform to re-evaluate the impact of bifurcation lesions in the current interventional era.
Purpose of the Study:
- To assess if bifurcation lesions still influence clinical outcomes after contemporary FFR-guided PCI with drug-eluting stents compared to CABG.
- To investigate the treatment effect of FFR-guided PCI versus CABG in patients with and without true bifurcation lesions.
Main Methods:
- Substudy analysis of the randomized FAME 3 trial (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation).
- Compared FFR-guided PCI using current drug-eluting stents with CABG in patients with 3-vessel coronary artery disease.
- Evaluated the composite endpoint of death, myocardial infarction, or stroke at 3-year follow-up, stratified by the presence of true bifurcation lesions.
Main Results:
- Of 1500 patients, 653 (45.2%) had at least one true bifurcation lesion.
- No significant difference in the composite endpoint was observed between patients with and without bifurcation lesions (11.6% vs. 10.0%, HR 1.17 [95% CI, 0.86-1.61]).
- The composite endpoint was not statistically different between FFR-guided PCI and CABG in patients with (HR 1.27 [95% CI, 0.80-2.00]) or without bifurcation lesions (HR 1.36 [95% CI, 0.87-2.12]), with no significant interaction.
Conclusions:
- The presence of a true bifurcation lesion did not impact clinical outcomes in patients with 3-vessel coronary artery disease treated with FFR-guided PCI or CABG.
- Contemporary PCI strategies have mitigated the adverse prognostic impact of bifurcation lesions previously observed with older techniques.
- Treatment strategy (PCI vs. CABG) did not yield significantly different outcomes based on the presence or absence of bifurcation lesions in this FFR-guided trial.
Background:
In the era of first-generation drug-eluting stents and angiography-guided percutaneous coronary intervention (PCI), the presence of a bifurcation lesion was associated with adverse outcomes after PCI. In contrast, the presence of a bifurcation lesion had no impact on outcomes following coronary artery bypass grafting (CABG). Therefore, the presence of a coronary bifurcation lesion requires special attention when choosing between CABG and PCI. The aim of this study is to assess whether the presence of a bifurcation lesion still influences clinical outcomes after contemporary PCI using second-generation drug-eluting stent and fractional flow reserve (FFR) guidance versus CABG.
Methods:
The randomized FAME 3 trial (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) compared FFR-guided PCI using current drug-eluting stents with CABG in patients with 3-vessel coronary artery disease. The prespecified key end point at 3-year follow-up was the composite of death, myocardial infarction, or stroke. In this substudy, the impact of bifurcation lesions on outcomes after FFR-guided PCI and CABG was investigated.
Results:
The FAME 3 trial enrolled 1500 patients and 653 (45.2%) patients had at least 1 true bifurcation lesion. There was no difference in the composite of death, myocardial infarction, or stroke at the 3-year follow-up between patients with or without at least 1 true bifurcation lesion (11.6% versus 10.0%; hazard ratio, 1.17 [95% CI, 0.86-1.61]; P=0.32), regardless of revascularization strategy. The composite end point was not statistically different between FFR-guided PCI and CABG in patients with at least 1 true bifurcation lesion (hazard ratio, 1.27 [95% CI, 0.80-2.00]) or without a true bifurcation lesion (hazard ratio, 1.36 [95% CI, 0.87-2.12]), with no significant interaction (Pinteraction=0.81).
Conclusions:
In patients with 3-vessel coronary artery disease, the presence of a true bifurcation lesion was not associated with a different treatment effect after FFR-guided PCI with contemporary drug-eluting stent versus CABG.
More Related Videos
13:48Reduction of Radiation Exposure during Endovascular Treatment of Peripheral Arterial Disease Combining Fiber Optic RealShape Technology and Intravascular Ultrasound
Published on: April 21, 2023
07:46Bilateral Common Carotid Artery Occlusion as an Adequate Preconditioning Stimulus to Induce Early Ischemic Tolerance to Focal Cerebral Ischemia
Published on: May 9, 2013
