Original Research

DOI: 10.4244/EIJ-D-24-00471

Final kissing balloon dilatation in patients with coronary bifurcation lesions treated with an upfront provisional stenting strategy

Ovidio De Filippo1, MD; Jeehoon Kang2, MD; Francesco Bruno1, MD; Young Bin Song3, MD; Salvatore Campagnuolo4, MD; Ki Hong Choi3, MD; Tineke H. Pinxterhuis5,6, MD; Hyun Kuk Kim7, MD; Alessio Mattesini8, MD; Yun-Kyeong Cho9, MD; Raffaele Piccolo10, MD, PhD; Hyun-Jong Lee11, MD; Wojciech Wańha12, MD; Bernardo Cortese13, MD; Seung Hwan Han14, MD, PhD; Leor Perl15, MD; Seung-Ho Hur9, MD; Domenico Tuttolomondo16, MD; Mario Iannaccone17, MD; Woo Jung Chun18, MD; Antonio Greco19, MD; Attilio Leone10, MD; Alessandra Truffa Giachet20, MD; Hyeon-Cheol Gwon3, MD; Giulio Stefanini21,22, MD, PhD; Hyo-Soo Kim2, MD; Javier Escaned23, PhD; Antonino Carmeci1, BS; Gianluca Campo24, MD; Giuseppe Patti25, MD; Davide Capodanno19, MD, PhD; Clemens von Birgelen5,6, MD, PhD; Bon-Kwon Koo2, MD, PhD; Gaetano Maria de Ferrari1,4, MD; Chang-Wook Nam9, MD, PhD; Fabrizio D’Ascenzo1,4, MD

Abstract

Background: The impact of final kissing balloon inflation (FKB) in patients treated with an upfront provisional strategy for coronary bifurcation lesions is controversial.

Aims: We aimed to assess the impact of FKB on patient- and lesion-oriented outcomes in a large real-world cohort.

Methods: The ULTRA-BIFURCAT registry was obtained by patient-level merging the BIFURCAT and ULTRA registries. Pairs of patients were generated with propensity score matching (PSM). The primary outcome of interest was major adverse cardiac events (MACE) − a composite of all-cause death, myocardial infarction (MI), target lesion revascularisation (TLR) or stent thrombosis. A lesion-oriented composite outcome (LOCO) − a composite of target vessel MI (TVMI) or TLR − along with each single component of MACE represented the secondary outcomes. Subgroup analyses included the site of bifurcation (unprotected left main [ULM] vs non-ULM), side branch involvement (true bifurcation vs non-true bifurcation), side branch diameter and lesion length. Follow-up was censored at 800 days.

Results: A total of 5,607 patients undergoing a provisional stenting technique were selected for the present analysis. PSM generated 1,784 pairs. Between the matched patients with FKB versus no FKB, no significant difference in MACE was observed (9.0% vs 8.6%; p=0.68). FKB was associated with a lower rate of the LOCO (1.9% vs 2.9%; p=0.04) compared to the no FKB group, driven by lower rates of TVMI (0.2% vs 0.5%; p=0.03) and TLR (1.8% vs 2.6%; p=0.14). These results were confirmed in the subgroups of patients treated for bifurcations with side branches with a diameter >2.5 mm and for true coronary bifurcation lesions.

Conclusions: Among patients treated for coronary bifurcation lesions with provisional stenting, FKB had no significant impact on MACE but was associated with a mild reduction in the incidence of the LOCO.

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Volume 21 Number 6
Mar 17, 2025
Volume 21 Number 6
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