{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T16:54:04Z","timestamp":1793638444673,"version":"4.5.1"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"41","license":[{"start":{"date-parts":[[2023,5,16]],"date-time":"2023-05-16T00:00:00Z","timestamp":1684195200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Capital's Funds for Health Improvement and Research","award":["2022-2-4033"],"award-info":[{"award-number":["2022-2-4033"]}]},{"name":"National High Level Hospital Clinical Research Funding","award":["2023-GSP-QN-34, 2023-GSP-RC-05, 2022-GSP-GG-20"],"award-info":[{"award-number":["2023-GSP-QN-34, 2023-GSP-RC-05, 2022-GSP-GG-20"]}]},{"name":"CAMS Innovation Fund for Medical Sciences","award":["2021-I2M-1-008"],"award-info":[{"award-number":["2021-I2M-1-008"]}]},{"name":"Science Foundation Ireland Research Professorship","award":["RSF15\/RP\/2765"],"award-info":[{"award-number":["RSF15\/RP\/2765"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>The present study sought to determine the rate and prognostic implications of post-procedural physiologically significant residual ischemia according to Murray law-based quantitative flow ratio (\u03bcQFR) after left main (LM) bifurcation percutaneous coronary intervention (PCI).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>Consecutive patients undergoing LM bifurcation stenting at a large tertiary care center between January 2014 and December 2016 with available post-PCI \u03bcQFR were included. Physiologically significant residual ischemia was defined by post-PCI \u03bcQFR values \u22640.80 in the left anterior descending (LAD) or left circumflex artery (LCX). The primary outcome was 3-year cardiovascular death. The major secondary outcome was 3-year bifurcation-oriented composite endpoint (BOCE). Among 1170 included patients with analyzable post-PCI \u03bcQFR, 155 (13.2%) had residual ischemia in either LAD or LCX. Patients with vs. those without residual ischemia had a higher risk of 3-year cardiovascular mortality [5.4% vs. 1.3%; adjusted hazard ratio (HR) 3.20, 95% confidence interval (CI): 1.16\u20138.80]. The 3-year risk of BOCE was significantly higher in the residual ischemia group (17.8% vs. 5.8%; adjusted HR 2.79, 95% CI: 1.68\u20134.64), driven by higher incidence of the composite of cardiovascular death and target bifurcation-related myocardial infarction (14.0% vs. 3.3%; adjusted HR 4.06, 95% CI: 2.22\u20137.42). A significant, inverse association was observed between continuous post-PCI \u03bcQFR and the risk of clinical outcomes (per 0.1 \u03bcQFR decrease, HR of cardiovascular death 1.27, 95% CI: 1.00\u20131.62; HR of BOCE 1.29, 95% CI: 1.14\u20131.47).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>After angiographically successful LM bifurcation PCI, residual ischemia assessed by \u03bcQFR was identified in 13.2% of patients and was associated with higher risk of 3-year cardiovascular death, indicating the superior prognostic value of post-PCI physiological assessment.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/eurheartj\/ehad318","type":"journal-article","created":{"date-parts":[[2023,5,16]],"date-time":"2023-05-16T03:06:45Z","timestamp":1684206405000},"page":"4324-4336","source":"Crossref","is-referenced-by-count":38,"title":["Left main bifurcation stenting: impact of residual ischaemia on cardiovascular mortality"],"prefix":"10.1093","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5634-0966","authenticated-orcid":false,"given":"Hao-Yu","family":"Wang","sequence":"first","affiliation":[{"name":"Cardiometabolic Medicine Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , A 167 Beilishi Rd, Xicheng District, Beijing 100037 , China"},{"name":"Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , A 167 Beilishi Rd, Xicheng District, Beijing 100037 , China"},{"name":"State Key Laboratory of Cardiovascular Disease, A 167 Beilishi Rd, Xicheng District, Beijing 100037, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Zhang","sequence":"additional","affiliation":[{"name":"Cardiometabolic Medicine Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , A 167 Beilishi Rd, Xicheng District, Beijing 100037 , China"},{"name":"Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , A 167 Beilishi Rd, Xicheng District, Beijing 100037 , China"},{"name":"State Key Laboratory of Cardiovascular Disease, A 167 Beilishi Rd, Xicheng District, Beijing 100037, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8372-6338","authenticated-orcid":false,"given":"Kefei","family":"Dou","sequence":"additional","affiliation":[{"name":"Cardiometabolic Medicine Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , A 167 Beilishi Rd, Xicheng District, Beijing 100037 , China"},{"name":"Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , A 167 Beilishi Rd, Xicheng District, Beijing 100037 , China"},{"name":"State Key Laboratory of Cardiovascular Disease, A 167 Beilishi Rd, Xicheng District, Beijing 100037, China"},{"name":"National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital Chinese Academy of Medical Sciences, A 12 Langshan Rd, Nanshan District, Shenzhen 518057, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunfei","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , A 167 Beilishi Rd, Xicheng District, Beijing 100037 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lihua","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , A 167 Beilishi Rd, Xicheng District, Beijing 100037 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zheng","family":"Qiao","sequence":"additional","affiliation":[{"name":"Cardiometabolic Medicine Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , A 167 Beilishi Rd, Xicheng District, Beijing 100037 , China"},{"name":"Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , A 167 Beilishi Rd, Xicheng District, Beijing 100037 , China"},{"name":"State Key Laboratory of Cardiovascular Disease, A 167 Beilishi Rd, Xicheng District, Beijing 100037, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tongqiang","family":"Zou","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , A 167 Beilishi Rd, Xicheng District, Beijing 100037 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changdong","family":"Guan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , A 167 Beilishi Rd, Xicheng District, Beijing 100037 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , A 167 Beilishi Rd, Xicheng District, Beijing 100037 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weixian","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , A 167 Beilishi Rd, Xicheng District, Beijing 100037 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongjian","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , A 167 Beilishi Rd, Xicheng District, Beijing 100037 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shengxian","family":"Tu","sequence":"additional","affiliation":[{"name":"Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University , Shanghai , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Wijns","sequence":"additional","affiliation":[{"name":"The Lambe Institute for Translational Medicine and Curam, University of Galway, Galway, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1165-7302","authenticated-orcid":false,"given":"Bo","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , A 167 Beilishi Rd, Xicheng District, Beijing 100037 , China"},{"name":"National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital Chinese Academy of Medical Sciences, A 12 Langshan Rd, Nanshan District, Shenzhen 518057, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,5,16]]},"reference":[{"key":"2023110616370160800_ehad318-B1","doi-asserted-by":"crossref","first-page":"4635","DOI":"10.1093\/eurheartj\/ehac542","article-title":"Left main coronary disease: evolving management concepts","volume":"43","author":"Armstrong","year":"2022","journal-title":"Eur Heart J"},{"key":"2023110616370160800_ehad318-B2","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1093\/eurheartj\/ehy394","article-title":"2018 ESC\/EACTS guidelines on myocardial revascularization","volume":"40","author":"Neumann","year":"2019","journal-title":"Eur Heart J"},{"key":"2023110616370160800_ehad318-B3","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.jacc.2021.09.005","article-title":"2021 ACC\/AHA\/SCAI guideline for coronary artery revascularization: executive summary: a report of the American College of Cardiology\/American Heart Association joint committee on clinical practice guidelines","volume":"79","author":"Lawton","year":"2022","journal-title":"J Am Coll Cardiol"},{"key":"2023110616370160800_ehad318-B4","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.jacasi.2021.12.011","article-title":"Percutaneous coronary intervention for left main coronary artery disease: present status and future perspectives","volume":"2","author":"Park","year":"2022","journal-title":"JACC Asia"},{"key":"2023110616370160800_ehad318-B5","doi-asserted-by":"crossref","first-page":"2247","DOI":"10.1016\/S0140-6736(21)02334-5","article-title":"Percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass grafting in left main coronary artery disease: an individual patient data meta-analysis","volume":"398","author":"Sabatine","year":"2021","journal-title":"Lancet"},{"key":"2023110616370160800_ehad318-B6","doi-asserted-by":"crossref","first-page":"1297","DOI":"10.1016\/j.jcin.2022.05.002","article-title":"Physiological approach for coronary artery bifurcation disease: position statement by Korean, Japanese, and European bifurcation clubs","volume":"15","author":"Lee","year":"2022","journal-title":"JACC Cardiovasc Interv"},{"key":"2023110616370160800_ehad318-B7","doi-asserted-by":"crossref","first-page":"2695","DOI":"10.1093\/eurheartj\/ehab186","article-title":"Immediate post-procedural functional assessment of percutaneous coronary intervention: current evidence and future directions","volume":"42","author":"Ding","year":"2021","journal-title":"Eur Heart J"},{"key":"2023110616370160800_ehad318-B8","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1016\/j.jcin.2019.02.037","article-title":"5-year outcomes according to FFR of left circumflex coronary artery after left main crossover stenting","volume":"12","author":"Lee","year":"2019","journal-title":"JACC Cardiovasc Interv"},{"key":"2023110616370160800_ehad318-B9","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1016\/j.jcin.2014.12.221","article-title":"Randomized comparison of FFR-guided and angiography-guided provisional stenting of true coronary bifurcation lesions: the DKCRUSH-VI trial (Double Kissing Crush Versus Provisional Stenting Technique for Treatment of Coronary Bifurcation Lesions VI)","volume":"8","author":"Chen","year":"2015","journal-title":"JACC Cardiovasc Interv"},{"key":"2023110616370160800_ehad318-B10","doi-asserted-by":"crossref","first-page":"1617","DOI":"10.1016\/j.jcin.2020.04.040","article-title":"The impact of coronary physiology on contemporary clinical decision making","volume":"13","author":"Kogame","year":"2020","journal-title":"JACC Cardiovasc Interv"},{"key":"2023110616370160800_ehad318-B11","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1002\/ccd.29592","article-title":"Diagnostic accuracy of quantitative flow ratio for assessment of coronary stenosis significance from a single angiographic view: a novel method based on bifurcation fractal law","volume":"97","author":"Tu","year":"2021","journal-title":"Catheter Cardiovasc Interv"},{"key":"2023110616370160800_ehad318-B12","first-page":"100399","article-title":"Quantitative flow ratio based on Murray fractal law: accuracy of single versus two angiographic views","volume":"1","author":"Ding","year":"2022","journal-title":"J Soc Cardiovasc Angiogr Interv"},{"key":"2023110616370160800_ehad318-B13","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.ijcard.2022.05.036","article-title":"Functional comparison of different jailed balloon techniques in treating non-left main coronary bifurcation lesions","volume":"364","author":"Wang","year":"2022","journal-title":"Int J Cardiol"},{"key":"2023110616370160800_ehad318-B14","doi-asserted-by":"crossref","first-page":"3077","DOI":"10.1016\/j.jacc.2017.10.035","article-title":"Diagnostic accuracy of angiography-based quantitative flow ratio measurements for online assessment of coronary stenosis","volume":"70","author":"Xu","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"2023110616370160800_ehad318-B15","doi-asserted-by":"crossref","first-page":"2149","DOI":"10.1016\/S0140-6736(21)02248-0","article-title":"Angiographic quantitative flow ratio-guided coronary intervention (FAVOR III China): a multicentre, randomised, sham-controlled trial","volume":"398","author":"Xu","year":"2021","journal-title":"Lancet"},{"key":"2023110616370160800_ehad318-B16","doi-asserted-by":"crossref","first-page":"1623","DOI":"10.1016\/j.jcin.2021.05.006","article-title":"Implications of periprocedural myocardial biomarker elevations and commonly used MI definitions after left main PCI","volume":"14","author":"Wang","year":"2021","journal-title":"JACC Cardiovasc Interv"},{"key":"2023110616370160800_ehad318-B17","doi-asserted-by":"crossref","first-page":"e011536","DOI":"10.1161\/CIRCINTERVENTIONS.121.011536","article-title":"New insights into long- versus short-term dual antiplatelet therapy duration in patients after stenting for left main coronary artery disease: findings from a prospective observational study","volume":"15","author":"Wang","year":"2022","journal-title":"Circ Cardiovasc Interv"},{"key":"2023110616370160800_ehad318-B18","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.jacc.2022.04.024","article-title":"Definitions and standardized endpoints for treatment of coronary bifurcations","volume":"80","author":"Lunardi","year":"2022","journal-title":"J Am Coll Cardiol"},{"key":"2023110616370160800_ehad318-B19","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1016\/j.jcin.2014.09.027","article-title":"The impact of downstream coronary stenosis on fractional flow reserve assessment of intermediate left main coronary artery disease: human validation","volume":"8","author":"Fearon","year":"2015","journal-title":"JACC Cardiovasc Interv"},{"key":"2023110616370160800_ehad318-B20","doi-asserted-by":"crossref","first-page":"e2232842","DOI":"10.1001\/jamanetworkopen.2022.32842","article-title":"Prognostic implications of fractional flow reserve after coronary stenting: a systematic review and meta-analysis","volume":"5","author":"Hwang","year":"2022","journal-title":"JAMA Netw Open"},{"key":"2023110616370160800_ehad318-B21","doi-asserted-by":"crossref","first-page":"1548","DOI":"10.1016\/j.jcin.2016.04.008","article-title":"Physiological severity of coronary artery stenosis depends on the amount of myocardial mass subtended by the coronary artery","volume":"9","author":"Kim","year":"2016","journal-title":"JACC Cardiovasc Interv"},{"key":"2023110616370160800_ehad318-B22","doi-asserted-by":"crossref","first-page":"2253","DOI":"10.1253\/circj.CJ-20-0661","article-title":"Comparison of optical flow ratio and fractional flow ratio in stent-treated arteries immediately after percutaneous coronary intervention","volume":"84","author":"Emori","year":"2020","journal-title":"Circ J"},{"key":"2023110616370160800_ehad318-B23","doi-asserted-by":"crossref","first-page":"2086","DOI":"10.1016\/j.jcin.2016.08.011","article-title":"Impact of operator experience and volume on outcomes after left main coronary artery percutaneous coronary intervention","volume":"9","author":"Xu","year":"2016","journal-title":"JACC Cardiovasc Interv"}],"container-title":["European Heart Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eurheartj\/advance-article-pdf\/doi\/10.1093\/eurheartj\/ehad318\/50308393\/ehad318.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurheartj\/article-pdf\/44\/41\/4324\/52692293\/ehad318.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurheartj\/article-pdf\/44\/41\/4324\/52692293\/ehad318.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,6]],"date-time":"2023-11-06T16:37:36Z","timestamp":1699288656000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurheartj\/article\/44\/41\/4324\/7161450"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,16]]},"references-count":23,"journal-issue":{"issue":"41","published-online":{"date-parts":[[2023,5,16]]},"published-print":{"date-parts":[[2023,11,1]]}},"URL":"https:\/\/doi.org\/10.1093\/eurheartj\/ehad318","relation":{},"ISSN":["0195-668X","1522-9645"],"issn-type":[{"value":"0195-668X","type":"print"},{"value":"1522-9645","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,11,1]]},"published":{"date-parts":[[2023,5,16]]}}}