The Proximal Optimization Technique Improves Clinical Outcomes When Treated without Kissing Ballooning in Patients with a Bifurcation Lesion
- Author:
Jeong Hoon YANG
1
;
Joo Myung LEE
;
Taek Kyu PARK
;
Young Bin SONG
;
Joo Yong HAHN
;
Jin Ho CHOI
;
Seung Hyuk CHOI
;
Cheol Woong YU
;
Woo Jung CHUN
;
Ju Hyeon OH
;
Bon Kwon KOO
;
Jin Ok JEONG
;
Hyo Soo KIM
;
Hyeon Cheol GWON
Author Information
- Publication Type:Original Article
- Keywords: Percutaneous coronary intervention; Coronary artery disease; Drug-eluting stents
- MeSH: Coronary Artery Disease; Death; Drug-Eluting Stents; Follow-Up Studies; Humans; Incidence; Myocardial Infarction; Percutaneous Coronary Intervention; Propensity Score; Treatment Outcome
- From:Korean Circulation Journal 2019;49(6):485-494
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND AND OBJECTIVES: There are limited data regarding the clinical efficacy of the proximal optimization technique (POT) in the treatment of coronary bifurcation lesions. We investigated the influence of POT on the clinical outcomes of patients with coronary bifurcation lesions. METHODS: We enrolled a total of 1,191 patients with a bifurcation lesion with a side branch (SB) diameter ≥2.5 mm treated with a drug-eluting stent from 18 centers between January 2003 and December 2009. The primary outcome was major adverse cardiac events (MACEs: cardiac death, myocardial infarction or target lesion revascularization [TLR]). We performed one-to-many (1:N) propensity score matching with non-fixed matching ratio. RESULTS: POT was performed in 252 patients. During follow-up (median 37 months), the incidence of MACE was lower in the POT group than it was in the non-POT group (adjusted hazard ratio, 0.43; 95% confidence interval [CI], 0.24–0.79; p=0.006). After propensity score matching, these were 0.34; 95% CI, 0.17–0.69; p=0.003 for MACE and 0.37; 95% CI, 0.17–0.78; p=0.01 for TLR. The use of POT was associated with significantly lower TLR in patients treated without kissing ballooning, but was not in those who underwent kissing ballooning (p for interaction=0.03). CONCLUSIONS: In coronary bifurcation lesions with a large SB, POT may be beneficial to improve long-term clinical outcome, particularly in patients treated without kissing ballooning during the procedure. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01642992
