Impact of Isolated Side Branch Lesions on Procedural Techniques and Outcomes of Bifurcation Percutaneous Coronary Intervention
ABSTRACT
Background
There is limited information on the impact of the isolated side branch lesions (ISBL) on the procedural techniques and outcomes of bifurcation percutaneous coronary intervention (PCI).
Aims
To examine the clinical, procedural and long-term outcomes of ISBL.
Methods
We examined the clinical, angiographic characteristics, and procedural outcomes of 1719 bifurcation PCIs in 1501 patients between 2014 and 2023 from the PROGRESS-BIFURCATION registry. A propensity score matched (PSM) Cox proportional hazards model was used to assess long-term outcomes.
Results
ISBL (Medina class 0,0,1) was present in 80 patients (5.3%). ISBL patients had similar baseline characteristics to the remaining patients, except for hypertension (90.0% vs. 79.2%, p = 0.020), prior PCI (66.3% vs. 44.5%, p < 0.001), and prior MI (50.6% vs. 35.2%, p = 0.006) that were more common in ISBL patients. ISBL had a median side branch diameter of 2.5 mm (interquartile range [IQR] 2.5−3.0), a median length of 10 mm (IQR 5−12), and a median side branch stenosis of 90% (IQR 80−95). The most common stenting strategies were side branch stenting (41.8%) and inverted provisional (25.5%). Technical and procedural success and in-hospital major adverse cardiovascular events (MACE) were similar in patients with and without ISBL. At 3-year follow-up, the incidence of MACE was higher in ISBL patients (36.3% vs. 26.4%, p = 0.043), driven by higher repeat target vessel PCI (26.8% vs. 12.0%; p = 0.003). On PSM adjusted Cox analysis, ISBL were independently associated with higher follow-up MACE (hazard ratio 1.58, 95% confidence intervals 1.13−2.20, p = 0.008).
Conclusions
PCI of ISBL was infrequent and was associated with similar technical and procedural success with non-ISBL but higher long-term MACE driven by higher TVR.
Conflicts of Interest
Dr. Yader Sandoval: Abbott (consultant, advisory board), Roche Diagnostics (consultant, advisory board, speaker), Philips (consultant, advisory board, speaker), Zoll (advisory board), GE Healthcare (consultant, advisory board), CathWorks (consultant), HeartFlow (speaker), Cleerly (speaker, research grant). He is an associate editor for JACC Advances. He and others hold patent 20210401347. Dr. M. Nicholas Burke: consulting and received speaker honoraria from Abbott Vascular and Boston Scientific. Dr. Emmanouil S. Brilakis: consulting/speaker honoraria from Abbott Vascular, American Heart Association (associate editor, Circulation), Amgen, Asahi Intecc, Biotronik, Boston Scientific, Cardiovascular Innovations Foundation (Board of Directors), CSI, Elsevier, GE Healthcare, IMDS, Medicure, Medtronic, Siemens, and Teleflex; research support: Boston Scientific, GE Healthcare; owner, Hippocrates LLC; shareholder: MHI Ventures, Cleerly Health, Stallion Medical.
Open Research
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
