Predicting Side Branch Occlusion in Acute Coronary Syndrome Using the Perfusion Balloon

Background Coronary bifurcation lesions account for 20% of all percutaneous coronary interventions. Acute coronary syndromes involve thrombotic conditions; however, methods for assessing this risk in thrombus‐containing bifurcations are unestablished. Aims This study aimed to determine whether perfusion balloon dilatation can predict the occurrence of side branch occlusion. Methods A total of 38 acute coronary syndrome patients with 65 side branches undergoing percutaneous coronary intervention using a perfusion balloon were enrolled. Based on the side branch flow during perfusion balloon dilatation, the branches were divided into PB‐SAFE (perfusion balloon side branch‐assisted flow stability, with side branch flow maintained) and not‐SAFE (with side branch flow loss) groups. Results The PB‐SAFE group did not have cases of side branch occlusion, whereas side branch occlusion occurred in 13 (31.7%) branches in the not‐SAFE group. Further, this group was identified as a significant predictor of side branch occlusion ( p < 0.01). In a lesion‐level multivariable analysis with per‐patient clustering, not‐SAFE remained an independent predictor of side branch occlusion (adjusted OR 20.8, 95% CI 4.08−106, p < 0.01). Conclusion The PB‐SAFE, our original predictor of side branch occlusion, can predict patients at risk of side branch occlusion during acute coronary syndrome bifurcation lesions.