Effect of FFR-Guided Delayed Revascularization on Patients with Borderline Lesions in the Proximal Left Anterior Descending Artery Accompanied by Grade Ⅱ Myocardial Bridging

Background and Aims This study determines if an FFR-guided deferred revascularization strategy benefits patients with Grade II myocardial bridging and proximal critical lesions—a tandem lesion-like physiology that may exacerbate ischemia—by avoiding unnecessary stent implants. Methods This retrospective analysis included 120 patients with chronic coronary syndrome (CCS) who were admitted to the Department of Cardiology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, between June 2023 and June 2024. All patients underwent coronary angiography (CAG) and fractional flow reserve (FFR) assessment, which revealed a grade II myocardial bridge (compression degree 50%–75%) in the left anterior descending artery (LAD) accompanied by a proximal borderline lesion (stenosis 50%–70%). Patients with FFR values in the gray zone (0.75 ≤ FFR < 0.80) were enrolled and randomly assigned via a random number table to either an interventional therapy group (observation group, n =60) or a medication therapy group (control group, n = 60). All patients were followed for 12 months. The primary endpoints included all-cause death, cardiac death, non-fatal myocardial infarction, and unplanned target vessel revascularization（TVR）. Secondary endpoints consisted of recurrent angina, positive exercise treadmill test results, and improvement in exercise tolerance. Results Results indicated no significant differences in baseline characteristics between the two groups (all P>0.05). There were also no statistically significant differences in the incidence of primary or secondary endpoint events (P>0.05). In the observation group, Seattle Angina Questionnaire (SAQ) scores improved from baseline in the domains of physical limitation (PL), treatment satisfaction (TS), angina stability (AS), and disease perception (DP). Similarly, the control group showed improvements in PL, TS, angina frequency (AF), and DP. Notably, the observation group achieved significantly higher scores in disease perception (DP) compared to the control group (P<0.05).Conclusion FFR-guided delayed revascularization is safe and effective for patients with borderline proximal lesions in the left anterior descending artery accompanied by grade II myocardial bridging, while conservative medical therapy can avoid unnecessary stent implantation. Conclusion FFR-guided delayed revascularization is relatively safe and effective for patients with borderline proximal lesions in the left anterior descending artery accompanied by grade II myocardial bridging, while conservative medical therapy can avoid unnecessary stent implantation.