Author + information
- Received August 12, 2016
- Revision received October 20, 2016
- Accepted November 17, 2016
- Published online March 20, 2017.
- Hyung Yoon Kim, MDa,
- Joon-Hyung Doh, MD, PhDb,∗∗ (, )
- Hong-Seok Lim, MD, PhDc,
- Chang-Wook Nam, MD, PhDd,
- Eun-Seok Shin, MD, PhDe,
- Bon-Kwon Koo, MD, PhDf,
- Joo Myung Lee, MDg,
- Taek Kyu Park, MDg,
- Jeong Hoon Yang, MD, PhDg,
- Young Bin Song, MD, PhDg,
- Joo-Yong Hahn, MD, PhDg,
- Seung Hyuk Choi, MD, PhDg,
- Hyeon-Cheol Gwon, MD, PhDg,
- Sang-Hoon Lee, MD, PhDg,
- Sung Mok Kim, MD, PhDh,
- Yeonhyeon Choe, MD, PhDh and
- Jin-Ho Choi, MD, PhDg,i,∗ ()
- aDepartment of Medicine, Jeju University Hospital, Jeju National University School of Medicine, Jeju, Korea
- bDepartment of Medicine, Inje University Ilsan-Paik Hospital, College of Medicine, Goyang, Korea
- cDepartment of Cardiology, Ajou University School of Medicine, Suwon, Korea
- dDepartment of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
- eDepartment of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
- fDepartment of Medicine, Seoul National University Hospital, Seoul, Korea
- gDepartment of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- hDepartment of Radiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- iDepartment of Emergency Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- ↵∗Address for correspondence:
Dr. Jin-Ho Choi, Sungkyunkwan University School of Medicine, Department of Internal Medicine, Department of Emergency Medicine, Samsung Medical Center, 81 Irwon-Ro, Gangnam-Gu, Seoul, 135-710 Korea.
- ↵∗∗Dr. Joon-Hyung Doh, Division of Cardiology, Department Internal Medicine, Ilsan-Paik Hospital, Inje University College of Medicine, Juwha-ro 170, Ilsanseo-gu, Goyang-si, Gyeonggi-do 10380, Korea.
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 = 482), only 1 of every 5 non-left main SB (n = 2,448) supplied %FMM ≥10% (97% vs. 21%; p < 0.001). SB length ≥73 mm could estimate %FMM ≥10% (c-statistic = 0.85; p < 0.001). In 604 vessels interrogated by FFR, diameter stenosis was similar (p = 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 = 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.
This study was supported by Korean Society of Interventional Cardiology grant 2014-1, Samsung Biomedical Research Institute grant GL1B33211, and Heart Vascular and Stroke Institute of Samsung Medical Center. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. H.Y. Kim and J.H. Doh equally contributed to this work as first authors. Drs. J.H. Choi and J.H. Doh contributed equally to this work as co-corresponding authors.
- Received August 12, 2016.
- Revision received October 20, 2016.
- Accepted November 17, 2016.
- 2017 American College of Cardiology Foundation