Background: Whether side branch (SB) predilation before main vessel (MV) stenting is beneficial is uncertain, so we investigated the effects of SB predilation on procedural and long-term outcomes in coronary bifurcation lesions treated using the provisional approach. Methods and Results: A total of 1,083 patients with true bifurcation lesions undergoing percutaneous coronary intervention were evaluated. The primary outcome was a major adverse cardiovascular event (MACE): cardiac death, myocardial infarction, or target lesion revascularization. SB predilation was performed in 437 (40.4%) patients. Abrupt (10.5% vs. 11.3%; P=0.76) or final SB occlusion (2.7% vs. 3.9%; P=0.41) showed no differences between the predilation and non-predilation groups. The rates of angiographic success (69.1% vs. 52.9%, P<0.001) and SB stent implantation (69.1% vs. 52.9%, P<0.001) were significantly higher in the predilation group. During a median follow-up of 36 months, we found no significant difference between the groups in the rate of MACE (9.4% vs. 11.5%; P=0.67) in a propensity score-matched population. In subgroup analysis, patients with minimal luminal diameter of the parent vessel ≤1 mm benefited from SB predilation in terms of preventing abrupt SB occlusion (P for interaction=0.04). Conclusions: For the treatment of true bifurcation lesions, SB predilation improved acute angiographic and procedural outcomes, but could not improve long-term clinical outcomes. It may benefit patients with severe stenosis in the parent vessel.
Bibliographical noteFunding Information:
Received September 6, 2017; revised manuscript received January 3, 2018; accepted February 1, 2018; released online March 23, 2018 Time for primary review: 27 days Department of Medicine, Heart, Stroke and Vascular Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Seung Hwa L., Y.B.S., J.M.L., T.K.P., J.H.Y., J.-Y.H., J.-H.C., S.-H.C., Sang Hoon L., H.-C.G.); Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (J.H.A., K.C.C.), Republic of Korea; Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta (K.C.C.), Canada; Chonnam National University Hospital, Gwangju (M.-H.J.); Seoul National University Hospital, Seoul (H.-S.K.); Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (J.H.O); and Yonsei University Severance Hospital, Seoul (Y.J.), Republic of Korea The first two authors contributed equally to this work (Seung Hwa L., Y.B.S.).
© 2018, Japanese Circulation Society. All rights reserved.
All Science Journal Classification (ASJC) codes
- Cardiology and Cardiovascular Medicine