Coronary interventions

Clinical outcomes of the proximal optimisation technique (POT) in bifurcation stenting

EuroIntervention 2021;17:e910-e918. DOI: 10.4244/EIJ-D-20-01393

Bernard Chevalier
Bernard Chevalier1, MD; Mamas A. Mamas2,3, MD; Thomas Hovasse1, MD; Muhammad Rashid2,3, MD; Joan Antoni Gómez-Hospital4, MD; Manuel Pan5, MD; Adam Witkowski6, MD; James Crowley7, MD; Adel Aminian8, MD; John McDonald9, MD; Farzin Beygui10,3, MD; Javier Fernandez Portales11, MD; Ariel Roguin12, MD; Goran Stankovic13, MD
1. Ramsay Générale de Santé, ICPS, Hôpital Jacques Cartier, Massy, France; 2. Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom; 3. Keele Cardiovascular Research Group, Centre of Prognosis Research, Institute of Primary Care Sciences, Keele University, Stoke-on-Trent, United Kingdom; 4. Heart Disease Institute, Bellvitge University Hospital (IDIBELL), University of Barcelona, Barcelona, Spain; 5. Reina Sofia Hospital, Department of Cardiology, University of Córdoba (IMIBIC), Cordoba, Spain; 6. Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland; 7. Department of Cardiology, University Hospital Galway, Galway, Ireland; 8. Centre Hospitalier Universitaire de Charleroi, Department of Cardiology, Charleroi, Belgium; 9. Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom; 10. Department of Interventional Cardiology and Cardiology Research Units, CHU Caen, Caen, France; 11. Department of Cardiology, Complejo Universitario Hospital de Caceres, Caceres, Spain; 12. Department of Cardiology, Hillel Yafe Medical Center, Hadera, Israel; 13. Department of Cardiology, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia

Background: Optimal deployment of coronary stents in a bifurcation lesion remains a matter of debate.

Aims: We sought to capture the daily practice of bifurcation stenting by means of a worldwide registry and to investigate how post-implantation deployment techniques influence clinical outcomes.

Methods: Data from the e-ULTIMASTER registry were used to perform an analysis of 4,395 patients undergoing percutaneous coronary intervention for bifurcation lesions. Inverse probability of treatment weights (IPTW) propensity score methodology was used to adjust for any baseline differences. The primary outcome of interest was target lesion failure (TLF) at one year (follow-up rate 96.2%).

Results: The global one-year TLF rate was low (5.1%). The proximal optimisation technique (POT) was used in 33.9% of cases and was associated with a reduction in the adjusted TLF rate (4.0% [95% confidence interval: 3.0-5.1%] vs 6.0% [5.1-6.9%], p<0.01) due to a reduction of all components of this composite endpoint, except for cardiac death. Stent thrombosis was also positively impacted (0.4% [0.04-0.7%] vs 1.3% [0.8-1.7%], p<0.01). POT benefit was uniform across subgroups. Conversely, the use of the kissing balloon technique (36.5%) did not influence the adjusted TLF rate.

Conclusions: Despite a low one-year failure rate in this large bifurcation stenting cohort, POT was associated with a further reduction in the event rate and a uniform benefit across subgroups, suggesting systematic use of this deployment technique regardless of the bifurcation anatomy and stenting technique.

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