Active Side‐Branch Protection Strategy for Culprit Bifurcation Lesion in STEMI Patients: The Multicenter STEMI‐BIF Registry

Background To date, the best side branch (SB) protection strategy in patients with coronary bifurcation lesions (CBLs)‐related ST‐segment elevation myocardial infarction (STEMI) has not yet been settled. Aims This study sought to evaluate the clinical outcome of the jailed balloon (JBT) and jailed wire techniques (JWT) for the SB protection strategy in STEMI patients with culprit CBLs. Methods This large‐scale multicenter ( n = 10) observational retrospective study included STEMI patients with culprit CBLs who underwent PCI with provisional stenting. The primary endpoint was major adverse cardiac events (MACE) as the combination of death from cardiac causes, target vessel myocardial infarction, or clinically driven target lesion revascularization (TLR). Propensity score‐matching analysis was performed. Results A total of 1218 consecutive patients (male: 1020 [83.7%], mean age: 57.68 ± 11.76 years) were included in this study. The study cohort was divided into two groups as JBT ( n = 196) and JWT ( n = 1022). The incidences of the SB intervention (21.4% vs. 36.2%, p < 0.001) and residual stenosis of SB ≥ 70% (23.0% vs. 45.5%, p < 0.001) were significantly lower in the JBT group compared to the JWT group. Whereas procedure time (47.21 ± 17.70 vs. 40.94 ± 13.18 min, p < 0.001) and fluoroscopy time (15.92 ± 9.51 vs. 13.39 ± 6.69 min, p = 0.001) were notably higher in the JBT group than in the JWT group. The risk‐adjusted midterm MACE (HR: 0.688, p = 0.200) and clinally driven TLR (HR: 0.566, p = 0.170) did not differ in individuals with culprit CBLs to protect the SB with JBT and the JWT in the propensity‐matched cohort. Conclusion The present study suggests that risk‐adjusted MACE and TLR rates were comparable between both techniques at midterm follow‐up.