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

Effect of FFR-Guided Delayed Revascularization on Patients with Borderline Lesions in the Proximal Left Anterior Descending Artery Accompanied by Grade Ⅱ Myocardial Bridging | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of FFR-Guided Delayed Revascularization on Patients with Borderline Lesions in the Proximal Left Anterior Descending Artery Accompanied by Grade Ⅱ Myocardial Bridging Zhiheng Fan, Kunheng Fan, Xiaowen Chen, Haibo Liu, Chuntao Wu, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8105618/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract 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. Fractional Flow Reserve Chronic Coronary Syndrome Myocardial Bridging Deferred Revascularization Borderline Lesion Introduction Percutaneous Coronary Intervention (PCI) can relieve coronary obstruction, restore blood flow, improve myocardial ischemia, enhance prognosis, and improve quality of life [ 1 ] . However, interventional indications should be strictly evaluated to avoid overtreatment. For borderline lesions (50%-70%), it is necessary to assess whether they cause ischemia and require interventional treatment based on the patient's specific condition and functional evaluation (such as FFR) [ 2 ] . Studies have found that myocardial bridging can cause myocardial ischemia and is associated with various clinical manifestations, including angina pectoris, myocardial infarction, and sudden cardiac death [ 3 ] . Myocardial bridging is most commonly found in the proximal and middle segments of the left anterior descending artery [ 4 ] . The hemodynamic differences between the vessels at both ends of the myocardial bridge may be related to the tendency of the proximal vessel to develop atherosclerotic stenosis [ 5 ] . When myocardial bridging coexists with proximal borderline lesions, the combination resembles a single-vessel tandem lesion, which may exacerbate myocardial ischemia. Research indicates that an FFR > 0.80 does not require coronary interventional intervention, while an FFR < 0.75 can induce myocardial ischemia and is an indication for coronary revascularization. For values in the range of 0.75 ≤ FFR < 0.80, which fall within the "gray zone," the decision for revascularization remains controversial [6]. This study enrolled patients with Chronic Coronary Syndrome (CCS). For patients with grade II myocardial bridging in the left anterior descending artery combined with proximal borderline lesions, the study aims to determine whether a delayed revascularization strategy guided by FFR can benefit patients. The goal is to minimize unnecessary stent implantation, achieve satisfactory therapeutic outcomes, alleviate the psychological pressure associated with "implantation," and reduce the bleeding risk associated with dual antiplatelet therapy after PCI. Patients and Methods Study design A total of 120 patients with chronic coronary syndrome (CCS), who were hospitalized in the Department of Cardiology at Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University between June 2023 and June 2024 for coronary angiography and were diagnosed with grade II myocardial bridging in the left anterior descending artery (LAD) combined with proximal borderline lesions, were selected as study subjects.and the inclusion criteria were the following:1.Patients with a clinical diagnosis of chronic coronary syndrome (CCS);2.Coronary angiography showing critical lesions (50%-70% stenosis) in the proximal left anterior descending artery accompanied by a grade II myocardial bridge (50%-75% compression), and for whom informed consent was obtained to enrol in this study. Exclusion criteria were as follows:1.Acute coronary syndrome (ACS) or a history of revascularization (PCI or CABG) involving the proximal-to-mid segment of the left anterior descending artery;2.Severe coronary tortuosity;3.Acute decompensated heart failure;4.Hypertrophic cardiomyopathy;5.Known contraindications to denosine triphosphate (ATP);6.Concurrent active infections, hepatic or renal failure, malignant tumors, or autoimmune disorders. Research Methods Collected data included age, gender, BMI, systolic blood pressure, diastolic blood pressure, smoking history, history of hypertension, history of diabetes, history of old myocardial infarction, history of heart failure, history of dilated cardiomyopathy, history of ischemic heart disease, history of hypertensive heart disease, history of atrial fibrillation, history of stroke, degree of coronary stenosis, FFR measurements, blood glucose, blood lipids, myocardial enzymes, renal function, and medications for coronary heart disease. Research Process and Grouping Method: Enrolled patients first underwent coronary angiography to assess the degree of coronary stenosis. Using the Seldinger technique via the radial or femoral artery, multiple angiographic views were obtained for each subject. Lesions in main vessels with a diameter ≥ 2.25 mm were evaluated. Patients with proximal borderline lesions in the LAD (50%-70% stenosis) accompanied by moderate myocardial bridging (50%-75% compression) were selected. FFR examination of the LAD was performed as follows: The pressure sensor was placed at the same level as the mid-axillary line. The pressure sensor was advanced just beyond the guiding catheter tip, and the pressure measured via the pressure wire was calibrated to match that measured via the guiding catheter. The pressure wire was then advanced to the distal end of the target vessel as far as possible. Adenosine triphosphate (ATP) was administered intravenously at 140-180 μg/(kg·min) to achieve a sustained and stable maximal hyperemic state in the target vessel. The FFR value was recorded via the pressure wire sensor. Patients with measured FFR values (0.75 ≤ FFR < 0.80) were included as study subjects. Using a digital random table method, the selected subjects were randomly divided into two groups:① Intervention Group: PCI + medication therapy for borderline lesions;② Medication-Alone Group: Medication therapy alone for borderline lesions.Patients were followed up every six months after discharge, with the last follow-up conducted in June 2024. The follow-up assessments were carried out via outpatient visits, telephone calls, WeChat communication, or scheduled re-hospitalization. The Seattle Angina Questionnaire (SAQ) was administered both before and after the treatment to evaluate the status and improvement of angina pectoris. Higher standard SAQ scores indicate better patient status in terms of quality of life and physiological function. During patient visits, the researchers explained the questionnaire contents. Patients who were capable of completing the questionnaire independently did so on their own. For those unable to complete it independently, trained researchers provided assistance. All collected questionnaires were reviewed, and the data were subsequently entered into the database.Primary Composite Endpoint: The incidence of major adverse cardiovascular events (MACE) within 1 year after discharge, including a composite endpoint of all-cause death, cardiac death, non-fatal myocardial infarction, acute heart failure, and unplanned target vessel revascularization. Secondary Endpoints: Recurrence of angina symptoms, positive exercise stress electrocardiogram results, evaluation of exercise tolerance. Statistical Methods: All data were processed using SPSS 25.0 software. Measurement data are expressed as mean ± standard deviation. Normality of the data was verified. For data conforming to a normal distribution, comparisons between two groups were performed using t-tests or analysis of variance (ANOVA). Non-normally distributed data are presented as median (interquartile range) and were analyzed using non-parametric tests. Count data are expressed as frequency (percentage) and were analyzed using the chi-square test or Fisher’s exact probability test. A P-value < 0.05 was considered statistically significant. Results 1. No statistically significant differences were observed between the two groups in terms of gender, age, history of revascularization, smoking history, hypertension history, diabetes history, thromboelastography maximum amplitude (MA) value, estimated glomerular filtration rate (eGFR), left ventricular ejection fraction, and oral medication usage (all P > 0.05). The P-value for eGFR was 0.060, indicating that the difference did not reach statistical significance but suggested a potential trend. This trend implies that the interventional therapy group might have higher eGFR values, although further expansion of the sample size is required to confirm this difference（Table 1）. table 1 Comparison of baseline data between the two groups of patients Variable Medication Group（n=60） PCI Group（n=57） T/χ 2 -value P-value Male/Female（n，%） 36/24 39/18 0.901 0.343 Age (years) 68（57～74） 69（59～74.5） -.827 0.408 History of revascularization 9（15.0%） 8（14.0%） 0.022 0.882 Smoke 21（35.0%） 22（38.6%） 0.163 0.687 Diabetes 29（48.3%） 26（45.6%） 0.087 0.768 Hypertension 44（73.3%） 49（86%） 2.860 0.091 MA-value 65.02±6.27 65.35±5.61 -.299 0.766 eGFR(ml/min/1.73 m 2 ) 93.67±7.29 95.18±8.21 1.8957 0.060 Glycated hemoglobin（%） 6.15（5.71～7.38） 6.35（5.63～7.68） -0.437 0.662 LVEF 0.62±0.07 0.60±0.07 1.517 0.132 Medication usage（n，%） Aspirin 59(98.33) 57(100) 0.958 0.328 Clopidogrel/Ticagrelor 46(76.67) 42(73.69) 0.139 0.709 Atorvastatin/Rosuvastatin 52(86.67) 53(92.98) 1.267 0.260 Nitrates 36(60.00) 25(50.88) 0.985 0.321 β-blockers 24(40.00) 27(47.37) 3.216 0.073 ACEI/ARB 38（63.33） 32（56.14） 0.629 0.428 2.Patients with chronic coronary syndrome who met the inclusion criteria and showed grade II myocardial bridging with proximal critical lesions in the LAD on angiography were randomized to either an interventional therapy group or a medication-only group. All enrolled subjects had no prior LAD intervention. No significant differences (all P > 0.05) were observed between the two groups in LAD myocardial bridge length, degree of compression, critical stenosis severity, stenosis length, or FFR values (Table 2). Table2 LAD Angiography and FFR Results in Both Groups Variable Medication Group（n=60） PCI Group（n=57） T/χ 2 -valu P-value Length of MB in the LAD（mm） 14.53±4.17 14.81±4.95 -.334 0.739 Degree of MB compression in the LAD（%） 57.58±6.54 58.16±6.86 -.464 0.644 Degree of LAD Critical Stenosis（%） 59.92±7.10 58.86±7.26 0.796 0.428 Length of LAD critical stenosis（mm） 17.32±4.14 17.58±3.61 -0.364 0.716 FFR-value 24.19±2.28 24.52±2.04 1.4868 0.1379 3.All patients were followed for one year. There was no statistically significant difference in the incidence of major adverse cardiovascular events (MACE) between the two groups (all P > 0.05; Table 3). Table3：Prognosis Comparison of the Two Groups[n，（%）] Variable Medication Group（n=60） PCI Group（n=57） T/χ 2 -value P -value Cardiac Death 0（0） 1（1.79） 1.062 0.303 Nonfatal MI 1（1.67） 0（0） 1.343 0.246 UTVR 5（8.3） 8（14.3） 0.147 0.702 AHF 2（3.3） 1（1.78） 0.275 0.600 4. No significant difference was found in the incidence of recurrent angina between the two groups (P > 0.05; Tables 4-5). In contrast, a statistically significant difference was observed in the incidence of positive treadmill exercise tests (P < 0.05; Table 4), which may be attributed to microvascular dysfunction and/or false-positive results in some patients. Table 4：Comparison of Secondary Clinical Endpoints Between the Two Groups [n，（%）] Variable Medication Group（n=60） PCI Group（n=57） T/χ 2 -value P -value recurrent angina events 10（16.67） 15（26.31） 1.620 0.203 positive treadmill test result 6（0.1） 11（0.193） 2.153 0.014 Table 5. Comparison of Recurrent Angina Between the Two Groups Variable recurrent angina events T/χ 2 -value P -value Np Non-recurrent Recurrent Medication Group 60 50 10（16.67） 1.620 0.203 PCI Group 57 42 15（26.31） Np：Patients 4.The study demonstrated that both the medication group and the interventional therapy group showed significant post-treatment improvements in their respective PL, TS, and DP scores (P < 0.05). Between-group analysis revealed that the interventional therapy group achieved a significantly higher DP score compared to the medication group (t = -2.65, P 0.05). Table 7. Comparison of Seattle Angina Questionnaire (SAQ) Scores Before and After Treatment in the Two Groups(±s) Variable Medication Group（n=60） PCI Group（n=57） Pretreatment Posttreatment Pretreatment Posttreatment PL score 67.97±5.64 71.00±6.05* 67.21±3.87 70.92±4.29* AS score 54.91±10.41 56.83±1.28* 54.53±10.71 55.91±12.58 AF score 67.59±9.24 69.82±8.76 64.34±13.23 68.11±12.87* TS score 61.26±4.81 65.18±7.14* 61.60±7.17 66.26±9.09* DP score 50.60±8.53 54.28±9.42* 49.75±10.63 58.63±8.48* # Note: *: P < 0.05 vs. before treatment in the same group; #: P < 0.05 vs. control group at the same time point. Discussion With the continuous development and innovation of percutaneous coronary intervention (PCI) technology, it has become a standard and essential method for myocardial revascularization in clinical practice. Future advancements in PCI should focus on further improving treatment efficacy, reducing complications, and optimizing clinical practice guidelines. For borderline lesions with 50%-70% stenosis, PCI is generally not indicated. However, revascularization can be considered if stress testing indicates functional myocardial ischemia or if corresponding criteria for coronary functional or intracoronary imaging assessments are met [ 6 ] . Intracoronary imaging techniques such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT) provide morphological guidance for stent sizing and precise positioning, thereby enhancing procedural success and safety. Nevertheless, since IVUS and OCT are primarily morphological assessments, they are limited in quantifying the actual impact of lesions on distal blood flow perfusion, particularly in cases of borderline lesions and/or concomitant myocardial bridging. Fractional flow reserve (FFR), mainly used for evaluating coronary borderline lesions, serves as a basis for determining the presence or absence of functional ischemia or the indication for PCI [ 7 ] , thereby compensating for the technical limitations of the aforementioned modalities. Through precise FFR assessment, patients with myocardial ischemia truly caused by myocardial bridging and borderline lesions can be identified, enabling targeted treatment and avoiding unnecessary stent implantation [ 8 ] . Studies indicate that the FFR cut-off value for determining PCI indication is 0.80. An FFR < 0.80 suggests an indication, < 0.75 indicates a strong indication, while ≥ 0.80 suggests no indication [ 9 ] . An FFR value between 0.75 and 0.80 falls within a "gray zone," where the decision for revascularization remains controversial [ 10 ] . In recent years, the concept of "intervention without implantation" has gained momentum. This strategy (represented by drug-coated balloons) avoids permanent implants, not only eliminating risks of in-stent restenosis and late stent thrombosis but also preserving the native vascular physiology and future revascularization options. It helps reduce stent-related complications and patient psychological burden, offering long-term benefits [ 11 , 12 , 13 ] . When a borderline lesion coexists with myocardial bridging, myocardial ischemia is undoubtedly exacerbated, necessitating FFR-assisted decision-making to ensure the most appropriate treatment strategy. Tajri et al. noted that the proximal segment of the left anterior descending artery near a myocardial bridge, due to its unique hemodynamic environment—including high wall shear stress and oscillatory flow—is predisposed to atherosclerosis [ 14 , 5 ] . Based on the severity of systolic compression caused by the myocardial bridge, classifications are: Grade I, compression 75% [ 15 ] . This study enrolled patients with proximal LAD borderline lesions accompanied by Grade II myocardial bridging (compression 50%–75%). Both factors may contribute to myocardial ischemia. However, it remains unclear whether the proximal borderline stenosis significantly restricts blood flow, whether revascularization is necessary, and whether patients benefit from PCI to relieve the fixed stenosis. Research shows that coronary heart disease patients with concomitant myocardial bridging who undergo stent implantation face significantly increased risks of in-stent restenosis, target lesion revascularization, and long-term major adverse cardiovascular events (MACE). Myocardial bridging is an independent risk factor for these adverse events [ 15 , 16 ] . The DEFER study confirmed that for coronary lesions with FFR ≥ 0.75, PCI did not improve long-term patient outcomes. The annual incidence of cardiac death or myocardial infarction was less than 1%, and PCI did not further reduce this risk. In contrast, medication therapy alone significantly reduced adverse events [ 17 ] . The FAME study further established the value of FFR in identifying ischemic lesions truly requiring PCI, demonstrating that FFR-guided PCI significantly reduced MACE rates in patients with multivessel disease. The FAME II study, focusing on patients with stable coronary artery disease, found that for lesions with FFR ≤ 0.80, PCI combined with medication therapy significantly reduced the incidence of composite endpoint events (death, myocardial infarction, or urgent revascularization) compared to medication therapy alone. Patients with FFR > 0.80 had favorable outcomes with medication therapy only [ 18 ] . Domestic research in this area is relatively limited. Yang Jinfeng et al [ 19 ] demonstrated that coronary myocardial bridging increases the incidence of restenosis after stent implantation in proximal stenotic segments, and the presence of myocardial bridging is a significant correlating factor for MACE after stent implantation in proximal stenotic lesions. Therefore, this study holds certain clinical significance. The lack of a statistically significant difference in the one-year post-discharge MACE endpoint between the two groups, coupled with improved Seattle Angina Questionnaire (SAQ) scores after treatment in both groups, suggests that for patients with chronic coronary syndrome (CCS) involving LAD Grade II myocardial bridging combined with proximal borderline lesions, an FFR-guided deferred revascularization strategy holds potential value for improving patient prognosis. On one hand, it avoids overtreatment of non-ischemia-driving lesions, reducing procedure-related trauma and risks, thereby helping to improve patients' quality of life. On the other hand, it provides a window for optimizing the condition for patients who might benefit from deferred revascularization. Through comprehensive management—including medication therapy and lifestyle interventions—the overall cardiovascular status of patients may be improved, potentially reducing the risk of future adverse cardiovascular events. In this study, the incidence of recurrent angina showed no statistically significant difference between the two groups (P > 0.05). The observation group had a significantly higher SAQ score in the disease perception (DP) domain than the control group (P < 0.05), which might be related to the observation group's proactive, structured disease education and higher compliance, leading to better disease understanding. However, this cognitive improvement alone is insufficient to support the notion that "intervention is superior." Conversely, a statistically significant difference was observed in the incidence of positive treadmill exercise tests between the groups. This may be because revascularization primarily addresses fixed stenosis, but since patients also had Grade II myocardial bridging, exercise-induced compression of the bridge might still contribute to ischemia. While treatment improved the fixed stenosis component, it could not alter the anatomical presence of the myocardial bridge. Thus, during maximal exercise, the effect of the myocardial bridge might become prominent, manifesting as objective ischemia positivity, even if patients experienced symptomatic relief due to improved fixed stenosis or potentially higher pain sensitivity in daily life. LIMITATIONS: The relatively small sample size may affect the generalizability of the findings. Future research should expand the sample size and conduct multi-center studies to more comprehensively and accurately evaluate the application value of the FFR-guided deferred revascularization strategy in patients with proximal LAD borderline lesions accompanied by Grade II myocardial bridging. Other limitations include the inherent biases of the retrospective design, lack of IVUS/OCT for plaque assessment, and non-evaluation of microvascular function. Furthermore, long-term follow-up data for patients during the deferred revascularization period remain insufficient. Future studies should strengthen research in this area to further investigate the impact of this strategy on patients' long-term outcomes. Declarations ETHICS STATEMENT: This study involving participants approved by the ethics committee of Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University (2023-32), All patients signed written informed consent. AUTHER CONTRIBUTIONS: All authors contributed to the article and approved the submitted version. ACKNOWLEDGEMENTS: We are grateful for all patients. FUNDING: This study was supported by a project from the Shanghai Qingpu District Science and Technology Commission（QKY2023-06）. CONFLICT OF INTEREST: The authors declare no conflict of interest. Clinical Trial Registration Number: Not applicable (This is a retrospective cohort study and has not been registered as a clinical trial). References Knuuti, J., Wijns, W., Saraste, A., Capodanno, D., Barbato, E., Funck-Brentano, C., ... & ESC Scientific Document Group. 2023 ESC Guidelines for the management of chronic coronary syndromes. European Heart Journal, 2023,44(28),2589–2589. Lorin, J. D,de Zélicourt, D.A.,et al. Myocardial Bridging and Adverse Outcomes in Patients With Anomalous Aortic Origin of a Coronary Artery.JACC: Cardiovascular Interventions,2023,16(18):2253-2264 Yong ASC,Pargaonkar VS,Wong CCY,et al.Abnormal shear stress and residence time are associated with proximal coronary athero ma in the presence of myocardial bridging[J].Int J Cardiol,2021,340:7-13 Chinese Expert Group on Clinical Pathway of Fractional Flow Reserve. Chen Yundai, Wang Jian'an. Chinese expert consensus on clinical pathway for fractional flow reserve measurement technology [J]. Chinese Journal of Interventional Cardiology, 2022, 30(8): 561-570 Chinese Society of Cardiology. [Chinese guidelines for percutaneous coronary intervention]. Zhonghua Xin Xue Guan Bing Za Zhi. 2025, 53(7): 16-44. Vrints C, Andreotti F, Koskinas KC, Rossello X, Adamo M, Ainslie J, Banning AP, Budaj A, Buechel RR, Chiariello GA, et al. 2024 ESC guidelines for the management of chronic coronary syndromes. Eur Heart J. 2024,45:ehae177. Kunadian V, Chieffo A, Camici PG, et al. Alternative methods for functional assessment of coronary artery stenosis. Position Paper from the European Association of Percutaneous Cardiovascular Interventions. Cardiol J.2020 Dec 31;27(6):825-853 Jennifer S , Jacqueline E,et al. 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.Circulation. 2022 Jan 18;145(3):e4-e17. Pijls NH，Fearon WF，Tonino PA，et al.Fractional flow reserve angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease:2-year follow-up of the FAME(Fractional Flow Reserve Versus Angiography for Multivessel Evaluation)study [J].Am Coll Cardiol,2010,56(3):177-184. Cao,C.,Ma,Y.,Li,Q., et al. Research Progress in Invasive Functional Assessment of Coronary Artery Disease. Chinese Journal of Interventional Cardiology, 2021, 29(3): 159-163. Antonio C,Pier PL,et al.Redefining the way to perform percutaneous coronary intervention: a view in search of evidence[J]Eur Heart J. 2023,44(41):4321-4323. Sun, Y., Teng, S., et al. Effect of Percutaneous Coronary Intervention on Postoperative Anxiety and Depression in Patients with Coronary Heart Disease. Chinese Journal of Radiological Health, 2021, 30(5): 632-637. Cortese B, Díaz Fernández J. F.et al.Leaving nothing behind": current strategies and future perspectives of dedicated invasive coronary interventions.Future Cardiology.2022,18,（6）：503-512 Tajri, B,Saw, J.et al.Myocardial Bridging: A Contemporary Review of Diagnostic and Therapeutic Strategies.Cardiology in Review.2023,31（5）：255-260 Chinese Research Hospital Association Expert Group on Coronary Myocardial Bridge. Expert Consensus on the Diagnosis and Treatment of Coronary Myocardial Bridging. Journal of Chinese Research Hospitals, 2022, 9(5): 1-8 Li, Y, Zhang, J, Li, J, et al.Impact of Myocardial Bridging on Long-Term Outcomes in Patients with Coronary Artery Disease After Percutaneous Coronary Intervention: A Propensity Score-Matched Analysis.Clinical Cardiology,2022,45（6）：601-611. Zimmermann,F.M,Pijls,et al.15-Year Follow-Up of the DEFER Trial: No Long-Term Harm of Deferring Revascularization of Coronary Stenoses With Normal Fractional Flow Reserve.Journal of the American College of Cardiology.2022,80（14）：1351-1359 De Bruyne, B., Pijls, N. H. J.,et al.Five-Year Outcomes with PCI Guided by Fractional Flow Reserve.New England Journal of Medicine.2018,379(3):250-259 Yang, J., Jia, X., et al. Application of Fractional Flow Reserve in the Evaluation of Myocardial Bridging and Its Combined Borderline Stenosis: Current Research Status. Advances in Cardiovascular Diseases, 2020,41(3): 313-316 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 13 Jan, 2026 Reviewers agreed at journal 13 Jan, 2026 Reviewers invited by journal 07 Jan, 2026 Editor invited by journal 11 Dec, 2025 Editor assigned by journal 10 Dec, 2025 Submission checks completed at journal 10 Dec, 2025 First submitted to journal 13 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8105618","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":570780520,"identity":"3c4fbfa5-4cbe-4b68-aa0f-107cd665c0f7","order_by":0,"name":"Zhiheng Fan","email":"","orcid":"","institution":"Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Zhiheng","middleName":"","lastName":"Fan","suffix":""},{"id":570780525,"identity":"a64d4a4d-b5df-4694-aaba-fa9a2929856b","order_by":1,"name":"Kunheng Fan","email":"","orcid":"","institution":"Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Kunheng","middleName":"","lastName":"Fan","suffix":""},{"id":570780533,"identity":"018c3d6a-e82d-4ef0-b57a-111c3cea55a7","order_by":2,"name":"Xiaowen Chen","email":"","orcid":"","institution":"Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Xiaowen","middleName":"","lastName":"Chen","suffix":""},{"id":570780535,"identity":"2565d0fd-2dfb-4652-8a1a-15fda3541a39","order_by":3,"name":"Haibo Liu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAsElEQVRIiWNgGAWjYBAC9hn8z398qLDh4WdvIFIL4wweBskZZ9JkJHsOkKBFmrPtsI3BDQcStBgznDnPw3CDgfHDxxyitPAfSC6ouM3DOLuBWXLmNiJtOTzjzG0eZpkDbMy8RGphbOZtO8fDJpFApBbBGTzMzLxtB3h4iNYiLcHDxjjjTDKPBM/BZuL8wid//hnDhwo7e/vjzQc/fCRGCxJgbCBN/SgYBaNgFIwC3AAAGKMy88RDS00AAAAASUVORK5CYII=","orcid":"","institution":"The Oriental 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12:23:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8105618/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8105618/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":99878550,"identity":"958cb940-70a7-4570-a89f-d02cfec780dc","added_by":"auto","created_at":"2026-01-09 10:44:21","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":37460,"visible":true,"origin":"","legend":"","description":"","filename":"EffectofFFRGuidedDelayedRevascularizationonPatientswithBorderlineLesionsintheProximalLeftAnteriorDescendingArteryAccompaniedbyGradeMyocardialBridging.docx","url":"https://assets-eu.researchsquare.com/files/rs-8105618/v1/ea0e0bf54d72fec95a98728b.docx"},{"id":99878553,"identity":"8b2c49af-2b21-4562-8e4b-aab49ad85a90","added_by":"auto","created_at":"2026-01-09 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08:46:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":502720,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8105618/v1/da73e384-40eb-4a04-9070-f2d12679703c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of FFR-Guided Delayed Revascularization on Patients with Borderline Lesions in the Proximal Left Anterior Descending Artery Accompanied by Grade Ⅱ Myocardial Bridging","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePercutaneous Coronary Intervention (PCI) can relieve coronary obstruction, restore blood flow, improve myocardial ischemia, enhance prognosis, and improve quality of life \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. However, interventional indications should be strictly evaluated to avoid overtreatment. For borderline lesions (50%-70%), it is necessary to assess whether they cause ischemia and require interventional treatment based on the patient's specific condition and functional evaluation (such as FFR) \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Studies have found that myocardial bridging can cause myocardial ischemia and is associated with various clinical manifestations, including angina pectoris, myocardial infarction, and sudden cardiac death \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Myocardial bridging is most commonly found in the proximal and middle segments of the left anterior descending artery \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. The hemodynamic differences between the vessels at both ends of the myocardial bridge may be related to the tendency of the proximal vessel to develop atherosclerotic stenosis \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. When myocardial bridging coexists with proximal borderline lesions, the combination resembles a single-vessel tandem lesion, which may exacerbate myocardial ischemia. Research indicates that an FFR\u0026thinsp;\u0026gt;\u0026thinsp;0.80 does not require coronary interventional intervention, while an FFR\u0026thinsp;\u0026lt;\u0026thinsp;0.75 can induce myocardial ischemia and is an indication for coronary revascularization. For values in the range of 0.75\u0026thinsp;\u0026le;\u0026thinsp;FFR\u0026thinsp;\u0026lt;\u0026thinsp;0.80, which fall within the \"gray zone,\" the decision for revascularization remains controversial [6]. This study enrolled patients with Chronic Coronary Syndrome (CCS). For patients with grade II myocardial bridging in the left anterior descending artery combined with proximal borderline lesions, the study aims to determine whether a delayed revascularization strategy guided by FFR can benefit patients. The goal is to minimize unnecessary stent implantation, achieve satisfactory therapeutic outcomes, alleviate the psychological pressure associated with \"implantation,\" and reduce the bleeding risk associated with dual antiplatelet therapy after PCI.\u003c/p\u003e"},{"header":"Patients and Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design\u0026nbsp;\u003c/strong\u003eA total of 120 patients with chronic coronary syndrome (CCS), who were hospitalized in the Department of Cardiology at Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University between June 2023 and June 2024 for coronary angiography and were diagnosed with grade II myocardial bridging in the left anterior descending artery (LAD) combined with proximal borderline lesions, were selected as study subjects.and the inclusion criteria were the following:1.Patients with a clinical diagnosis of chronic coronary syndrome (CCS);2.Coronary angiography showing critical lesions (50%-70% stenosis) in the proximal left anterior descending artery accompanied by a grade II myocardial bridge (50%-75% compression), and for whom informed consent was obtained to enrol in this study.\u003c/p\u003e\n\u003cp\u003eExclusion criteria were as follows:1.Acute coronary syndrome (ACS) or a history of revascularization (PCI or CABG) involving the proximal-to-mid segment of the left anterior descending artery;2.Severe coronary tortuosity;3.Acute decompensated heart failure;4.Hypertrophic cardiomyopathy;5.Known contraindications to denosine triphosphate (ATP);6.Concurrent active infections, hepatic or renal failure, malignant tumors, or autoimmune disorders.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch Methods\u003cbr\u003e\u003c/strong\u003eCollected data included age, gender, BMI, systolic blood pressure, diastolic blood pressure, smoking history, history of hypertension, history of diabetes, history of old myocardial infarction, history of heart failure, history of dilated cardiomyopathy, history of ischemic heart disease, history of hypertensive heart disease, history of atrial fibrillation, history of stroke, degree of coronary stenosis, FFR measurements, blood glucose, blood lipids, myocardial enzymes, renal function, and medications for coronary heart disease.\u003c/p\u003e\n\u003cp\u003eResearch Process and Grouping Method:\u003cbr\u003e\u0026nbsp;Enrolled patients first underwent coronary angiography to assess the degree of coronary stenosis. Using the Seldinger technique via the radial or femoral artery, multiple angiographic views were obtained for each subject. Lesions in main vessels with a diameter ≥ 2.25 mm were evaluated. Patients with proximal borderline lesions in the LAD (50%-70% stenosis) accompanied by moderate myocardial bridging (50%-75% compression) were selected. FFR examination of the LAD was performed as follows: The pressure sensor was placed at the same level as the mid-axillary line. The pressure sensor was advanced just beyond the guiding catheter tip, and the pressure measured via the pressure wire was calibrated to match that measured via the guiding catheter. The pressure wire was then advanced to the distal end of the target vessel as far as possible. Adenosine triphosphate (ATP) was administered intravenously at 140-180 μg/(kg·min) to achieve a sustained and stable maximal hyperemic state in the target vessel. The FFR value was recorded via the pressure wire sensor. Patients with measured FFR values (0.75 ≤ FFR \u0026lt; 0.80) were included as study subjects. Using a digital random table method, the selected subjects were randomly divided into two groups:① Intervention Group: PCI + medication therapy for borderline lesions;② Medication-Alone Group: Medication therapy alone for borderline lesions.Patients were followed up every six months after discharge, with the last follow-up conducted in June 2024. The follow-up assessments were carried out via outpatient visits, telephone calls, WeChat communication, or scheduled re-hospitalization. The Seattle Angina Questionnaire (SAQ) was administered both before and after the treatment to evaluate the status and improvement of angina pectoris. Higher standard SAQ scores indicate better patient status in terms of quality of life and physiological function. During patient visits, the researchers explained the questionnaire contents. Patients who were capable of completing the questionnaire independently did so on their own. For those unable to complete it independently, trained researchers provided assistance. All collected questionnaires were reviewed, and the data were subsequently entered into the database.Primary Composite Endpoint:\u003cbr\u003e\u0026nbsp;The incidence of major adverse cardiovascular events (MACE) within 1 year after discharge, including a composite endpoint of all-cause death, cardiac death, non-fatal myocardial infarction, acute heart failure, and unplanned target vessel revascularization.\u003c/p\u003e\n\u003cp\u003eSecondary Endpoints:\u003cbr\u003e\u0026nbsp;Recurrence of angina symptoms, positive exercise stress electrocardiogram results, evaluation of exercise tolerance.\u003c/p\u003e\n\u003cp\u003eStatistical Methods:\u003cbr\u003e\u0026nbsp;All data were processed using SPSS 25.0 software. Measurement data are expressed as mean ± standard deviation. Normality of the data was verified. For data conforming to a normal distribution, comparisons between two groups were performed using t-tests or analysis of variance (ANOVA). Non-normally distributed data are presented as median (interquartile range) and were analyzed using non-parametric tests. Count data are expressed as frequency (percentage) and were analyzed using the chi-square test or Fisher’s exact probability test. A P-value \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e1. No statistically significant differences were observed between the two groups in terms of gender, age, history of revascularization, smoking history, hypertension history, diabetes history, thromboelastography maximum amplitude (MA) value, estimated glomerular filtration rate (eGFR), left ventricular ejection fraction, and oral medication usage (all P \u0026gt; 0.05). The P-value for eGFR was 0.060, indicating that the difference did not reach statistical significance but suggested a potential trend. This trend implies that the interventional therapy group might have higher eGFR values, although further expansion of the sample size is required to confirm this difference（Table 1）.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 577px;\"\u003e\n \u003cp\u003e\u0026nbsp;table 1 \u0026nbsp;Comparison of baseline data between the two groups of patients\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eMedication Group（n=60）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePCI Group（n=57）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cem\u003eT/\u0026chi;\u003csup\u003e2\u003c/sup\u003e-value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eMale/Female（n，%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e36/24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e39/18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.901\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.343\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e68（57～74）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e69（59～74.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e-.827\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.408\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eHistory of revascularization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e9（15.0%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e8（14.0%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.882 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eSmoke\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e21（35.0%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e22（38.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.687\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e29（48.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e26（45.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.768\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e44（73.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e49（86%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e2.860\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eMA-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e65.02\u0026plusmn;6.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e65.35\u0026plusmn;5.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e-.299\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.766\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eeGFR(ml/min/1.73 m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e93.67\u0026plusmn;7.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e95.18\u0026plusmn;8.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e1.8957\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.060\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eGlycated hemoglobin（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e6.15（5.71～7.38）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e6.35（5.63～7.68）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e-0.437\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.662\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eLVEF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e0.62\u0026plusmn;0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e0.60\u0026plusmn;0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e1.517\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.132\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eMedication usage（n，%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eAspirin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e59(98.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e57(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.958\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.328\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eClopidogrel/Ticagrelor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e46(76.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e42(73.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.139\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.709\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eAtorvastatin/Rosuvastatin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e52(86.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e53(92.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e1.267\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.260\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eNitrates\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e36(60.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e25(50.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.985\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.321\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026beta;-blockers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e24(40.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e27(47.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e3.216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eACEI/ARB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e38（63.33）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e32（56.14）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.629\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.428\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e2.Patients with chronic coronary syndrome who met the inclusion criteria and showed grade II myocardial bridging with proximal critical lesions in the LAD on angiography were randomized to either an interventional therapy group or a medication-only group. All enrolled subjects had no prior LAD intervention. No significant differences (all P \u0026gt; 0.05) were observed between the two groups in LAD myocardial bridge length, degree of compression, critical stenosis severity, stenosis length, or FFR values (Table 2).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"580\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 580px;\"\u003e\n \u003cp\u003eTable2\u0026nbsp;LAD Angiography and FFR Results in Both Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 249px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eMedication Group（n=60）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003ePCI Group（n=57）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e\u003cem\u003eT/\u0026chi;\u003csup\u003e2\u003c/sup\u003e-valu\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 249px;\"\u003e\n \u003cp\u003eLength of MB in the LAD（mm）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e14.53\u0026plusmn;4.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e14.81\u0026plusmn;4.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e-.334\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.739\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 249px;\"\u003e\n \u003cp\u003eDegree of MB compression in the LAD（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e57.58\u0026plusmn;6.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e58.16\u0026plusmn;6.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e-.464\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.644\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 249px;\"\u003e\n \u003cp\u003eDegree of LAD Critical Stenosis（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e59.92\u0026plusmn;7.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e58.86\u0026plusmn;7.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.796\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.428\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 249px;\"\u003e\n \u003cp\u003eLength of LAD critical stenosis（mm）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e17.32\u0026plusmn;4.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e17.58\u0026plusmn;3.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e-0.364\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.716\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 249px;\"\u003e\n \u003cp\u003eFFR-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e24.19\u0026plusmn;2.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e24.52\u0026plusmn;2.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e1.4868\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.1379\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e3.All patients were followed for one year. There was no statistically significant difference in the incidence of major adverse cardiovascular events (MACE) between the two groups (all\u0026nbsp;P\u0026nbsp;\u0026gt; 0.05; Table 3).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"556\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 429px;\"\u003e\n \u003cp\u003e\u0026nbsp;Table3：Prognosis Comparison of the Two Groups[n，（%）]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eMedication Group（n=60）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003ePCI Group（n=57）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cem\u003eT/\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003cem\u003e-value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003cem\u003e-value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003eCardiac Death\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e0（0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1（1.79）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e1.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e0.303\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003eNonfatal MI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e1（1.67）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0（0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e1.343\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e0.246\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003eUTVR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e5（8.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e8（14.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e0.147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e0.702\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003eAHF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e2（3.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1（1.78）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e0.275\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e0.600\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e4. No significant difference was found in the incidence of recurrent angina between the two groups (P\u0026nbsp;\u0026gt; 0.05; Tables 4-5). In contrast, a statistically significant difference was observed in the incidence of positive treadmill exercise tests (P\u0026nbsp;\u0026lt; 0.05; Table 4), which may be attributed to microvascular dysfunction and/or false-positive results in some patients.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"660\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 540px;\"\u003e\n \u003cp\u003eTable 4：Comparison of Secondary Clinical Endpoints Between the Two Groups\u0026nbsp;[n，（%）]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 169px;\"\u003e\n \u003cp\u003eMedication Group（n=60）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003ePCI Group（n=57）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cem\u003eT/\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003cem\u003e-value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003cem\u003e-value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003erecurrent angina events\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 169px;\"\u003e\n \u003cp\u003e10（16.67）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003e15（26.31）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e1.620\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e0.203\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003epositive treadmill test result\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 169px;\"\u003e\n \u003cp\u003e6（0.1）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003e11（0.193）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e2.153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"615\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 615px;\"\u003e\n \u003cp\u003eTable 5. Comparison of Recurrent Angina Between the Two Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 126px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 489px;\"\u003e\n \u003cp\u003erecurrent angina events\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cem\u003eT/\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003cem\u003e-value\u003c/em\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003cem\u003eP\u003c/em\u003e\u003cem\u003e-value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eNp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;Non-recurrent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003eRecurrent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eMedication Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e10（16.67）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e1.620\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e0.203\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003ePCI Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e15（26.31）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 615px;\"\u003e\n \u003cp\u003eNp：Patients\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e4.The study demonstrated that both the medication group and the interventional therapy group showed significant post-treatment improvements in their respective PL, TS, and DP scores (P \u0026lt; 0.05). Between-group analysis revealed that the interventional therapy group achieved a significantly higher DP score compared to the medication group (t = -2.65, P \u0026lt; 0.05; Table 7), while no other significant differences were observed in the remaining post-treatment scores between the groups (P \u0026gt; 0.05).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 545px;\"\u003e\n \u003cp\u003eTable 7. Comparison of Seattle Angina Questionnaire (SAQ) Scores Before and After Treatment in the Two Groups(\u0026plusmn;s)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 72px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 208px;\"\u003e\n \u003cp\u003eMedication Group（n=60）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 245px;\"\u003e\n \u003cp\u003ePCI Group（n=57）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003ePretreatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ePosttreatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003ePretreatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003ePosttreatment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003ePL score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e67.97\u0026plusmn;5.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e71.00\u0026plusmn;6.05*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e67.21\u0026plusmn;3.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e70.92\u0026plusmn;4.29*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eAS score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e54.91\u0026plusmn;10.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e56.83\u0026plusmn;1.28*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e54.53\u0026plusmn;10.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e55.91\u0026plusmn;12.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eAF score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e67.59\u0026plusmn;9.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e69.82\u0026plusmn;8.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e64.34\u0026plusmn;13.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e68.11\u0026plusmn;12.87*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eTS score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e61.26\u0026plusmn;4.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e65.18\u0026plusmn;7.14*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e61.60\u0026plusmn;7.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e66.26\u0026plusmn;9.09*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eDP score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e50.60\u0026plusmn;8.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e54.28\u0026plusmn;9.42*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e49.75\u0026plusmn;10.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e58.63\u0026plusmn;8.48*\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 545px;\"\u003e\n \u003cp\u003eNote:\u0026nbsp;*: P \u0026lt; 0.05 vs. before treatment in the same group; #: P \u0026lt; 0.05 vs. control group at the same time point.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWith the continuous development and innovation of percutaneous coronary intervention (PCI) technology, it has become a standard and essential method for myocardial revascularization in clinical practice. Future advancements in PCI should focus on further improving treatment efficacy, reducing complications, and optimizing clinical practice guidelines. For borderline lesions with 50%-70% stenosis, PCI is generally not indicated. However, revascularization can be considered if stress testing indicates functional myocardial ischemia or if corresponding criteria for coronary functional or intracoronary imaging assessments are met \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Intracoronary imaging techniques such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT) provide morphological guidance for stent sizing and precise positioning, thereby enhancing procedural success and safety. Nevertheless, since IVUS and OCT are primarily morphological assessments, they are limited in quantifying the actual impact of lesions on distal blood flow perfusion, particularly in cases of borderline lesions and/or concomitant myocardial bridging. Fractional flow reserve (FFR), mainly used for evaluating coronary borderline lesions, serves as a basis for determining the presence or absence of functional ischemia or the indication for PCI \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e, thereby compensating for the technical limitations of the aforementioned modalities. Through precise FFR assessment, patients with myocardial ischemia truly caused by myocardial bridging and borderline lesions can be identified, enabling targeted treatment and avoiding unnecessary stent implantation \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. Studies indicate that the FFR cut-off value for determining PCI indication is 0.80. An FFR\u0026thinsp;\u0026lt;\u0026thinsp;0.80 suggests an indication, \u0026lt;\u0026thinsp;0.75 indicates a strong indication, while\u0026thinsp;\u0026ge;\u0026thinsp;0.80 suggests no indication \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. An FFR value between 0.75 and 0.80 falls within a \"gray zone,\" where the decision for revascularization remains controversial \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn recent years, the concept of \"intervention without implantation\" has gained momentum. This strategy (represented by drug-coated balloons) avoids permanent implants, not only eliminating risks of in-stent restenosis and late stent thrombosis but also preserving the native vascular physiology and future revascularization options. It helps reduce stent-related complications and patient psychological burden, offering long-term benefits \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWhen a borderline lesion coexists with myocardial bridging, myocardial ischemia is undoubtedly exacerbated, necessitating FFR-assisted decision-making to ensure the most appropriate treatment strategy. Tajri et al. noted that the proximal segment of the left anterior descending artery near a myocardial bridge, due to its unique hemodynamic environment\u0026mdash;including high wall shear stress and oscillatory flow\u0026mdash;is predisposed to atherosclerosis \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Based on the severity of systolic compression caused by the myocardial bridge, classifications are: Grade I, compression\u0026thinsp;\u0026lt;\u0026thinsp;50%; Grade II, compression 50%\u0026ndash;75%; Grade III, compression\u0026thinsp;\u0026gt;\u0026thinsp;75% \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. This study enrolled patients with proximal LAD borderline lesions accompanied by Grade II myocardial bridging (compression 50%\u0026ndash;75%). Both factors may contribute to myocardial ischemia. However, it remains unclear whether the proximal borderline stenosis significantly restricts blood flow, whether revascularization is necessary, and whether patients benefit from PCI to relieve the fixed stenosis. Research shows that coronary heart disease patients with concomitant myocardial bridging who undergo stent implantation face significantly increased risks of in-stent restenosis, target lesion revascularization, and long-term major adverse cardiovascular events (MACE). Myocardial bridging is an independent risk factor for these adverse events \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. The DEFER study confirmed that for coronary lesions with FFR\u0026thinsp;\u0026ge;\u0026thinsp;0.75, PCI did not improve long-term patient outcomes. The annual incidence of cardiac death or myocardial infarction was less than 1%, and PCI did not further reduce this risk. In contrast, medication therapy alone significantly reduced adverse events \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. The FAME study further established the value of FFR in identifying ischemic lesions truly requiring PCI, demonstrating that FFR-guided PCI significantly reduced MACE rates in patients with multivessel disease. The FAME II study, focusing on patients with stable coronary artery disease, found that for lesions with FFR\u0026thinsp;\u0026le;\u0026thinsp;0.80, PCI combined with medication therapy significantly reduced the incidence of composite endpoint events (death, myocardial infarction, or urgent revascularization) compared to medication therapy alone. Patients with FFR\u0026thinsp;\u0026gt;\u0026thinsp;0.80 had favorable outcomes with medication therapy only \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. Domestic research in this area is relatively limited. Yang Jinfeng et al\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e demonstrated that coronary myocardial bridging increases the incidence of restenosis after stent implantation in proximal stenotic segments, and the presence of myocardial bridging is a significant correlating factor for MACE after stent implantation in proximal stenotic lesions.\u003c/p\u003e \u003cp\u003eTherefore, this study holds certain clinical significance. The lack of a statistically significant difference in the one-year post-discharge MACE endpoint between the two groups, coupled with improved Seattle Angina Questionnaire (SAQ) scores after treatment in both groups, suggests that for patients with chronic coronary syndrome (CCS) involving LAD Grade II myocardial bridging combined with proximal borderline lesions, an FFR-guided deferred revascularization strategy holds potential value for improving patient prognosis. On one hand, it avoids overtreatment of non-ischemia-driving lesions, reducing procedure-related trauma and risks, thereby helping to improve patients' quality of life. On the other hand, it provides a window for optimizing the condition for patients who might benefit from deferred revascularization. Through comprehensive management\u0026mdash;including medication therapy and lifestyle interventions\u0026mdash;the overall cardiovascular status of patients may be improved, potentially reducing the risk of future adverse cardiovascular events.\u003c/p\u003e \u003cp\u003eIn this study, the incidence of recurrent angina showed no statistically significant difference between the two groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The observation group had a significantly higher SAQ score in the disease perception (DP) domain than the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), which might be related to the observation group's proactive, structured disease education and higher compliance, leading to better disease understanding. However, this cognitive improvement alone is insufficient to support the notion that \"intervention is superior.\" Conversely, a statistically significant difference was observed in the incidence of positive treadmill exercise tests between the groups. This may be because revascularization primarily addresses fixed stenosis, but since patients also had Grade II myocardial bridging, exercise-induced compression of the bridge might still contribute to ischemia. While treatment improved the fixed stenosis component, it could not alter the anatomical presence of the myocardial bridge. Thus, during maximal exercise, the effect of the myocardial bridge might become prominent, manifesting as objective ischemia positivity, even if patients experienced symptomatic relief due to improved fixed stenosis or potentially higher pain sensitivity in daily life.\u003c/p\u003e\n\u003ch3\u003eLIMITATIONS:\u003c/h3\u003e\n\u003cp\u003eThe relatively small sample size may affect the generalizability of the findings. Future research should expand the sample size and conduct multi-center studies to more comprehensively and accurately evaluate the application value of the FFR-guided deferred revascularization strategy in patients with proximal LAD borderline lesions accompanied by Grade II myocardial bridging. Other limitations include the inherent biases of the retrospective design, lack of IVUS/OCT for plaque assessment, and non-evaluation of microvascular function. Furthermore, long-term follow-up data for patients during the deferred revascularization period remain insufficient. Future studies should strengthen research in this area to further investigate the impact of this strategy on patients' long-term outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eETHICS STATEMENT:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study involving participants approved by the ethics committee of Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University (2023-32), All patients signed written informed consent.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAUTHER CONTRIBUTIONS:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the article and approved the submitted version.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eACKNOWLEDGEMENTS:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe are grateful for all patients.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFUNDING:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study was supported by a project from the Shanghai Qingpu District Science and Technology Commission（QKY2023-06）.\u003c/p\u003e\n\u003cp\u003eCONFLICT OF INTEREST:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003eClinical Trial Registration Number: Not applicable (This is a retrospective cohort study and has not been registered as a clinical trial).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKnuuti, J., Wijns, W., Saraste, A., Capodanno, D., Barbato, E., Funck-Brentano, C., ... \u0026amp; ESC Scientific Document Group. 2023 ESC Guidelines for the management of chronic coronary syndromes. European Heart Journal, 2023,44(28),2589\u0026ndash;2589.\u003c/li\u003e\n\u003cli\u003eLorin, J. D,de Z\u0026eacute;licourt, D.A.,et al. Myocardial Bridging and Adverse Outcomes in Patients With Anomalous Aortic Origin of a Coronary Artery.JACC: Cardiovascular Interventions,2023,16(18):2253-2264\u003c/li\u003e\n\u003cli\u003eYong ASC,Pargaonkar VS,Wong CCY,et al.Abnormal shear stress and residence time are associated with proximal coronary athero ma in the presence of myocardial bridging[J].Int J Cardiol,2021,340:7-13\u003c/li\u003e\n\u003cli\u003eChinese Expert Group on Clinical Pathway of Fractional Flow Reserve. Chen Yundai, Wang Jian\u0026apos;an. Chinese expert consensus on clinical pathway for fractional flow reserve measurement technology [J]. Chinese Journal of Interventional Cardiology, 2022, 30(8): 561-570\u003c/li\u003e\n\u003cli\u003eChinese Society of Cardiology. [Chinese guidelines for percutaneous coronary intervention]. Zhonghua Xin Xue Guan Bing Za Zhi. 2025, 53(7): 16-44.\u003c/li\u003e\n\u003cli\u003eVrints C, Andreotti F, Koskinas KC, Rossello X, Adamo M, Ainslie J, Banning AP, Budaj A, Buechel RR, Chiariello GA, et al. 2024 ESC guidelines for the management of chronic coronary syndromes. Eur Heart J. 2024,45:ehae177.\u003c/li\u003e\n\u003cli\u003eKunadian V, Chieffo A, Camici PG, et al. Alternative methods for functional assessment of coronary artery stenosis. Position Paper from the European Association of Percutaneous Cardiovascular Interventions. Cardiol J.2020 Dec 31;27(6):825-853 \u003c/li\u003e\n\u003cli\u003eJennifer S , Jacqueline E,et al. 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.Circulation. 2022 Jan 18;145(3):e4-e17.\u003c/li\u003e\n\u003cli\u003ePijls NH，Fearon WF，Tonino PA，et al.Fractional flow reserve angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease:2-year follow-up of the FAME(Fractional Flow Reserve Versus Angiography for Multivessel Evaluation)study [J].Am Coll Cardiol,2010,56(3):177-184.\u003c/li\u003e\n\u003cli\u003eCao,C.,Ma,Y.,Li,Q., et al. Research Progress in Invasive Functional Assessment of Coronary Artery Disease. Chinese Journal of Interventional Cardiology, 2021, 29(3): 159-163.\u003c/li\u003e\n\u003cli\u003eAntonio C,Pier PL,et al.Redefining the way to perform percutaneous coronary intervention: a view in search of evidence[J]Eur Heart J. 2023,44(41):4321-4323.\u003c/li\u003e\n\u003cli\u003eSun, Y., Teng, S., et al. Effect of Percutaneous Coronary Intervention on Postoperative Anxiety and Depression in Patients with Coronary Heart Disease. Chinese Journal of Radiological Health, 2021, 30(5): 632-637.\u003c/li\u003e\n\u003cli\u003eCortese B, D\u0026iacute;az Fern\u0026aacute;ndez J. F.et al.Leaving nothing behind\u0026quot;: current strategies and future perspectives of dedicated invasive coronary interventions.Future Cardiology.2022,18,（6）：503-512\u003c/li\u003e\n\u003cli\u003eTajri, B,Saw, J.et al.Myocardial Bridging: A Contemporary Review of Diagnostic and Therapeutic Strategies.Cardiology in Review.2023,31（5）：255-260\u003c/li\u003e\n\u003cli\u003eChinese Research Hospital Association Expert Group on Coronary Myocardial Bridge. Expert Consensus on the Diagnosis and Treatment of Coronary Myocardial Bridging. Journal of Chinese Research Hospitals, 2022, 9(5): 1-8\u003c/li\u003e\n\u003cli\u003eLi, Y, Zhang, J, Li, J, et al.Impact of Myocardial Bridging on Long-Term Outcomes in Patients with Coronary Artery Disease After Percutaneous Coronary Intervention: A Propensity Score-Matched Analysis.Clinical Cardiology,2022,45（6）：601-611.\u003c/li\u003e\n\u003cli\u003eZimmermann,F.M,Pijls,et al.15-Year Follow-Up of the DEFER Trial: No Long-Term Harm of Deferring Revascularization of Coronary Stenoses With Normal Fractional Flow Reserve.Journal of the American College of Cardiology.2022,80（14）：1351-1359\u003c/li\u003e\n\u003cli\u003eDe Bruyne, B., Pijls, N. H. J.,et al.Five-Year Outcomes with PCI Guided by Fractional Flow Reserve.New England Journal of Medicine.2018,379(3):250-259\u003c/li\u003e\n\u003cli\u003eYang, J., Jia, X., et al. Application of Fractional Flow Reserve in the Evaluation of Myocardial Bridging and Its Combined Borderline Stenosis: Current Research Status. Advances in Cardiovascular Diseases, 2020,41(3): 313-316\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Fractional Flow Reserve, Chronic Coronary Syndrome, Myocardial Bridging, Deferred Revascularization, Borderline Lesion","lastPublishedDoi":"10.21203/rs.3.rs-8105618/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8105618/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground and Aims\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis 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 \u0026lt; 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResults indicated no significant differences in baseline characteristics between the two groups (all P\u0026gt;0.05). There were also no statistically significant differences in the incidence of primary or secondary endpoint events (P\u0026gt;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\u0026lt;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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFFR-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.\u003c/p\u003e","manuscriptTitle":"Effect of FFR-Guided Delayed Revascularization on Patients with Borderline Lesions in the Proximal Left Anterior Descending Artery Accompanied by Grade Ⅱ Myocardial Bridging","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-09 10:44:16","doi":"10.21203/rs.3.rs-8105618/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-01-13T20:20:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"327241247453292355099996120050016015975","date":"2026-01-13T20:07:55+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-07T10:53:18+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-11T16:35:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-10T10:45:32+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-10T10:43:16+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cardiovascular Disorders","date":"2025-11-13T12:08:29+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d53f266c-41fc-469f-9df3-b94226832674","owner":[],"postedDate":"January 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-09T10:44:16+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-09 10:44:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8105618","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8105618","identity":"rs-8105618","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}