The Proximal Optimization Technique Improves Clinical Outcomes When Treated without Kissing Ballooning in Patients with a Bifurcation Lesion

Jeong Hoon Yang, 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, Jeong Hoon Yang, 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

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.

Keywords: Coronary artery disease; Drug-eluting stents; Percutaneous coronary intervention.

Conflict of interest statement

The authors have no financial conflicts of interest.

Copyright © 2019. The Korean Society of Cardiology.

Figures

Figure 1. Cumulative incidence functions in POT…
Figure 1. Cumulative incidence functions in POT versus non-POT groups from a competing risk proportional hazard model for MACE. (A) Cumulative incidence functions for MACEs in POT (solid line) versus non-POT groups (dashed line) in all patients. (B) Cumulative incidence functions for MACEs in POT versus non-POT groups in propensity-matched populations.
MACE = major adverse cardiac event; POT = proximal optimization technique; PS = propensity-score.
Figure 2. Comparative unadjusted HRs of MACE…
Figure 2. Comparative unadjusted HRs of MACE for subgroups in all population. The association of POT with better TLR outcomes was consistent across various subgroups without a significant interaction.
HR = hazard ratio; FKB = final kissing ballooning; MACE = major adverse cardiac event; POT = proximal optimization technique; TLR = target lesion revascularization.
Figure 3. Comparative unadjusted HRs of TLR…
Figure 3. Comparative unadjusted HRs of TLR for subgroups in all population. There was a significant interaction between the use of POT and TLR according to the presence or absence of final kissing ballooning.
HR = hazard ratio; FKB = final kissing ballooning; POT = proximal optimization technique; TLR = target lesion revascularization.

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Source: PubMed

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