Instantaneous Wave-Free Ratio-Guided Interventions in Side Branches Improve Results in Bifurcation Lesions Compared to Conventional Techniques

Abstract

Background: In coronary lesions characterized by bifurcation anatomies, provisional side-branch intervention is the preferred treatment approach. However, there is a well-documented discrepancy between angiographic evaluations of blood flow obstruction and the actual functional severity of bifurcation lesions. Additionally, the use of fractional flow reserve (FFR) carries notable side effects primarily associated with the necessity of adenosine administration. Given the demonstrated noninferiority of the instantaneous wave-free ratio (iFR) compared to FFR, this study aimed to assess the clinical and functional benefits of iFR-guided side-branch ballooning which involving drug-eluting balloon inflation in side branch in comparison to conventional intervention techniques for bifurcation lesions.

Methods: In this prospective cohort study, a total of 100 patients with coronary lesions characterized by bifurcation anatomies were enrolled and randomly assigned to two groups: the iFR-based intervention group, which utilized only side-branch intervention involving drug-eluting balloon inflation, and the conventional intervention group. Both groups were monitored for 12 months postintervention to assess various clinical and functional endpoints.

Results: In the iFR-guided group, only 2 patients (4%) met the primary endpoint (a composite of target bifurcation-related nonfatal myocardial infarction, target bifurcation revascularization, and any unplanned revascularization) compared to 10 patients (20%) in the conventional group (p = 0.01). The study also demonstrated the superiority of iFR-guided drug-eluting balloon inflation in side branches over conventional interventional procedures for bifurcation lesions, as evidenced by a reduction in fluoroscopy time (mean difference [MD] = −8.9 min, 95% confidence interval [CI] = −15.6 to −2.1, p = 0.01), intervention duration (MD = −11.6 min, 95% CI = −20.5 to −2.8, p = 0.01), and length of hospital stay (MD = −1 day, 95% CI = −1.2 to −0.80, p < 0.0001). Additionally, the amount of contrast media used in the iFR-guided intervention group was significantly lower than that in the conventional treatment group (p < 0.0001).

Conclusions: iFR-guided side-branch intervention involving drug-eluting balloon inflation in bifurcation lesions was significantly better when compared to conventional interventions in terms of clinical and functional outcomes in patients with coronary lesions characterized by bifurcation anatomies.