Clinical outcomes of FFR and IVUS-guided PCI in patients with myocardial bridging and proximal LAD stenosis.

Background: Myocardial bridging (MB), once considered benign, is increasingly recognized for its role in myocardial ischemia, especially when coexisting with proximal left anterior descending (LAD) artery stenosis. Optimal revascularization strategies remain uncertain for such dual pathology. This study assessed whether a fractional flow reserve (FFR)-guided and intravascular ultrasound (IVUS)-optimized percutaneous coronary intervention (PCI) approach improves outcomes in this population. Methods: In this retrospective single-center study, 238 patients with moderate MB and proximal intermediate LAD stenosis were enrolled. Patients were stratified based on FFR measurements: those with FFR > 0.80 received medical therapy alone (n = 96), while patients with FFR ≤ 0.80 underwent IVUS-guided PCI (n = 142). Baseline characteristics, procedural data, and two-year follow-up outcomes were compared. Major adverse cardiovascular events (MACE) were recorded, and multivariate regression analysis identified predictors of poor outcomes. Results: Patients undergoing PCI (FFR ≤ 0.80) had significantly lower MACE rates than those managed conservatively (7.7% vs. 18.8%, p = 0.019), mainly due to reduced angina-related rehospitalization. PCI was an independent protective factor (Hazard Ratio = 0.526, p = 0.034). Among PCI patients, stent extension into the MB segment was linked with higher MACE incidence (18.6% vs. 3.0%, p = 0.001). IVUS revealed that stent extension correlated with severe MB compression, shorter distance between lesions, and more frequent dissections. Two anatomical factors-short MB-proximal lesion distance and MB dissection-were predictive of poor outcomes post-MB stenting. Conclusions: An FFR-guided, IVUS-supported PCI strategy improves clinical outcomes in patients with MB and proximal LAD stenosis, particularly when avoiding stent placement in dynamically compressed MB segments. Procedural planning using IVUS and careful lesion assessment is essential. Functional evaluation alone may underestimate ischemia in MB; integration of anatomical and diastolic functional indices is recommended.