Computational fluid dynamic-derived wall shear stress of non-significant left main bifurcation disease may predict acute vessel thrombosis at 3-year follow-up

Wall shear stress (WSS) plays a pivotal role on plaque progression in coronary artery disease. We assess the prognostic role of baseline mean WSS in developing a bifurcation-located myocardial infarction (B-MI) over the following 3 years in angiographically non-significant LM bifurcation disease. For this purpose, we retrospectively reviewed the procedural and medical records of consecutive patients evaluated in our center from 1st January 2014 to 1st January 2019 who had a non-significant LM bifurcation disease as evaluated at coronary computed tomography angiography (CCTA) and confirmed by coronary angiography. Each bifurcation model was reconstructed on the patient-specific geometries derived from the CCTA. The population was divided into two groups: patients with ( n = 12) and without B-MI ( n = 20) over the following 3 years. Both the mean WSS prox of each branch and the WSS entire_lesion of each vessel, adjusted for the respective mean lesions lengths and 3-dimensional percentage of stenosis (DS%), resulted in independent predictors of 3-year B-MI. Multivariate Cox-regression analysis confirmed that a baseline mean WSS entire_model ≥ 5.05 Pa (HR 1.98, 95% CI 1.83–2.10, p = 0.001) was a predictor of 3-year B-MI independently from the entire mean lesions lengths (HR 1.56. 95% CI 1.43.1.68, p = 0.002) and DS% (HR 1.26, 95% CI 1.18–1.37, p = 0.03). In conclusion, in patients with angiographically non-significant LM bifurcation disease, both the mean WSS prox of each branch and WSS entire_lesion of each stenotic vessel predicted the occurrence of B-MI over the following 3 years. Moreover, the WSS entire_bifurcation ≥ 5.05 Pa seems to be a predictor of 3-year B-MI independently from the DS% and lesions lengths.