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

Proximal Optimisation Technique Versus Final Kissing Balloon Inflation in Coronary Bifurcation Lesions: the Randomised, Multicenter PROPOT Trial

DOI: 10.4244/EIJ-D-20-01386

1. apartment of Medicine, Division of Cardiology, Teikyo University School of Medicine, Tokyo, Japan, Japan
2. Department of Cardiology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
3. Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
4. Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
5. Department of Cardiology, Gifu Heart Center, Gifu, Japan
6. Department of Cardiology, Yokohama Rosai Hospital, Yokohama, Japan
7. Department of Cardiology, Ageo Central General Hospital, Ageo, Japan
8. Department of Cardiology, Kobe University Graduate School of Medicine, Kobe, Japan
9. Department of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
10. Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
11. Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
12. Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
13. Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
14. Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
15. Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
16. Department of Biostatistics, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
17. Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France
18. Division of Cardiology, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
19. Department of Medicine, Division of Cardiology, Teikyo University School of Medicine, Tokyo, Japan

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Background: Clinical implications of proximal optimisation technique (POT) for bifurcation lesions have not been investigated in a randomised controlled trial.

Aims: This study aimed to investigate whether proximal optimisation technique (POT) is superior in terms of stent apposition compared with the conventional kissing balloon technique (KBT) in real-life bifurcation lesions using optical coherence tomography (OCT).

Methods: A total of 120 patients from 15 centres were randomised into two groups: POT followed by side branch dilation or KBT. Finally, 57 and 58 patients in the POT and KBT groups, respectively, were analysed. OCT was performed at baseline, immediately after wire recrossing to the side branch, and at the final procedure.

Results: The primary endpoint was the rate of malapposed struts assessed by the final OCT. The rate of malapposed struts did not differ between the POT and KBT groups (in-stent proximal site: 10.4% vs. 7.7%, p=0.33; bifurcation core: 1.4% vs. 1.1%, p=0.67; core’s distal edge: 6.2% vs. 5.3%, p=0.59). More additional treatments were required among the POT group (40.4% vs. 6.9%, p<0.01). At 1-year follow-up, only one patient in each group underwent target lesion revascularisation (2.0% vs. 1.9%).

Conclusions: POT followed by side branch dilation did not show any advantages over conventional KBT in terms of stent apposition, however, the excellent mid-term clinical outcomes were observed in both strategies.

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