Impact of Bifurcation Lesions on Outcomes After FFR-Guided PCI or CABG

Daimy M M Dillen; Hisao Otsuki; Kuniaki Takahashi; Yuhei Kobayashi; Zsolt Piroth; Nicolas Noiseux; Badih El Nakadi; Gintaras Kalinauskas; Laszlo Szekely; Giedrius Davidavičius; Koen Teeuwen; Pim A L Tonino; Nico H J Pijls; Bernard De Bruyne; William F Fearon; Frederik M Zimmermann

doi:10.1161/CIRCINTERVENTIONS.124.014610

Impact of Bifurcation Lesions on Outcomes After FFR-Guided PCI or CABG

Circ Cardiovasc Interv. 2024 Dec 27:e014610. doi: 10.1161/CIRCINTERVENTIONS.124.014610. Online ahead of print.

Authors

Daimy M M Dillen¹, Hisao Otsuki², Kuniaki Takahashi², Yuhei Kobayashi³, Zsolt Piroth⁴, Nicolas Noiseux⁵, Badih El Nakadi⁶, Gintaras Kalinauskas⁷, Laszlo Szekely⁸, Giedrius Davidavičius⁹, Koen Teeuwen¹, Pim A L Tonino^{1

10}, Nico H J Pijls¹, Bernard De Bruyne¹¹, William F Fearon², Frederik M Zimmermann^{1

12}

Affiliations

¹ Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands (D.M.M.D., K. Teeuwen, P.A.L.T., N.H.J.P., F.M.Z.).
² Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford University, CA (H.O., K. Takahashi, W.F.F.).
³ New York Presbyterian Brooklyn Methodist and Weill Cornell Medical College (Y.K.).
⁴ Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P.).
⁵ Department of Cardiothoracic Surgery, Centre Hospitalier de l'Universite de Montreal, Quebec, Canada (N.N.).
⁶ Department of Cardiothoracic Surgery, Centre Hospitalier Universitaire de Charleroi, Belgium (B.E.N.).
⁷ Department of Cardiothoracic Surgery, Vilnius University Hospital Santaros Klinikos, Lithuania (G.K.).
⁸ Department of Cardiothoracic Surgery, Gottsegen National Cardiovascular Center, Budapest, Hungary (L.S.).
⁹ Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, Lithuania (G.D.).
¹⁰ Department of Biomedical Engineering, Technical University Eindhoven, the Netherlands (P.A.L.T.).
¹¹ Cardiovascular Center Aalst, OLV Clinic, Belgium (B.D.B.).
¹² Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (F.M.Z.).

PMID: 39727036
DOI: 10.1161/CIRCINTERVENTIONS.124.014610

Abstract

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 (P_interaction=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.

Keywords: angiography; coronary artery bypass; drug-eluting stents; myocardial infarction; percutaneous coronary intervention; stroke.