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: = 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: = 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.