Efficacy of intravascular imaging in the treatment of patients with ‘false’ bifurcation lesions of the left main coronary artery: a three-year follow-up study

Objective. To evaluate efficacy and safety of percutaneous coronary intervention (PCI) in patients with ‘false’ bifurcation lesions of the left main coronary artery (LMCA) using intravascular imaging techniques. Material and methods. There were 176 patients with ‘false’ bifurcation lesions of LMCA verified by angiography. Patients were randomized into 2 groups depending on imaging modality. In group 1 (n=88), patients underwent intravascular ultrasound (IVUS), in group 2 (n=88) — optical coherence tomography (OCT). According to inclusion criteria, 140 patients were included in the study after imaging. Patients with minimal luminal area (MLA) in terminal part of LMCA<6 mm2 underwent PCI. Patients with MLA >6 mm2 (n=48) and fractional blood flow reserve (FFR) >0.8 were followed-up. In the 1st group, patients underwent provisional stenting with subsequent FFR measurement and stent position control (IVUS or OCT). If FFR in native branch was<0.8, patients received the second stent («revers-crush» or «revers-cullote»). The procedure was terminated if FFR was >0.8. Results. After 36 months, myocardial infarction (MI) rates were 14.0% and 4.8% (p=0.103), target lesion revascularization (TLR) rates — 8.0% and 7.14% (p=0.398), cardiac mortality rates — 6.0% and 2.4% (p=0.623), major adverse cardiovascular events (MACE) — 22.0% and 16.7% (p=0.280), respectively. Revascularization was delayed in 27.3% of patients in both groups (p>0.05). Three-year survival was 100%. MI was detected in 12.5% and 4.2% (p=0.486), TLR — in 12.5% and 8.3% (p=0.658), MACE — in 20.8% and 12.5% (p=0.699), respectively. Conclusion. IVUS or OCT with equal efficacy improve the outcomes in patients with ‘false’ bifurcation lesions of LMCA and allow for safe deferral of revascularization. Post-PCI FFR measurement in these patients allows early detection of residual ischemia and modification of intraoperative tactics for higher efficiency and safety of PCI.