Korean Circ J.  2019 Jun;49(6):485-494. 10.4070/kcj.2018.0352.

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

• Yang JH
• Lee JM
• Park TK
• Song YB
• Hahn JY
• Choi JH
• Choi SH
• Yu CW
• Chun WJ
• Oh JH
• Koo BK
• Jeong JO
• Kim HS
• Gwon HC

• KMID: 2454043
• DOI: http://doi.org/10.4070/kcj.2018.0352

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

Keyword

Percutaneous coronary intervention; Coronary artery disease; Drug-eluting stents

MeSH Terms

Coronary Artery Disease
Death
Drug-Eluting Stents
Follow-Up Studies
Humans
Incidence
Myocardial Infarction
Percutaneous Coronary Intervention
Propensity Score
Treatment Outcome

Figure

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  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.

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  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.

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  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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