Ovidio Filippo; Jeehoon Kang; Francesco Bruno; Young Bin Song; Salvatore Campagnuolo; Ki Hong Choi; Tineke Pinxterhuis; Hyun Kuk Kim; Alessio Mattesini; Yun-Kyeong Cho; Raffaele Piccolo; Hyun-Jong Lee; Wojciech Wańha; Bernardo Cortese; Seung Hwan Han; Leor Perl; Seung-Ho Hur; Domenico Tuttolomondo; Mario Iannaccone; Woo Jung Chun; Antonio Greco; Attilio Leone; Alessandra Giachet; Hyeon-Cheol Gwon; Giulio Stefanini; Hyo-Soo Kim; Javier Escaned; Antonino Carmeci; Gianluca Campo; Giuseppe Patti; Davide Capodanno; Clemens von Birgelen; Bon-Kwon Koo; Gaetano De Ferrari; Chang-Wook Nam; Fabrizio D’ascenzo

doi:10.4244/EIJ-D-24-00471

The Official Journal of EuroPCR and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

The reference multimedia journal in interventional cardiology

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

1. Division of Cardiology, Cardiovascular and Thoracic Department, A.O.U. Città della Salute e della Scienza, Turin, Italy; 2. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea; 3. Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; 4. Department of Medical Sciences, University of Turin, Turin, Italy; 5. Department of Cardiology, Thorax Centrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands; 6. Department of Health Technology and Services Research, BMS Faculty, Technical Medical Centre, University of Twente, Enschede, the Netherlands; 7. Department of Internal Medicine and Cardiovascular Center, Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Republic of Korea; 8. Cardiologia Interventistica, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; 9. Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea; 10. Department of Advanced Biomedical Sciences, Division of Cardiology, University of Naples Federico II, Naples, Italy; 11. Department of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea; 12. Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland; 13. Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy and DCB Academy, Milan, Italy; 14. Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea; 15. Cardiology Department, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel; 16. Cardiology Unit, University Hospital of Parma, Parma, Italy; 17. Division of Cardiology, Ospedale San Giovanni Bosco, Turin, Italy; 18. Department of Internal Medicine, Samsung Changwon Hospital, Changwon, Republic of Korea; 19. Azienda Ospedaliero-Universitaria Policlinico “G. Rodolico-San Marco”, University of Catania, Catania, Italy; 20. Division of Cardiology, Ivrea Hospital, Ivrea, Italy; 21. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; 22. IRCCS Humanitas Research Hospital, Rozzano, Italy; 23. Hospital Clínico San Carlos IdISSC, Complutense University of Madrid and CIBER-CV, Madrid, Spain; 24. Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy; 25. University of Eastern Piedmont “Amedeo Avogadro”, Novara, Italy

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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