Key result
Side branch predilatation in provisional bifurcation PCI linked to higher procedural success without reducing in-hospital MACE.
Why the study?
Does side branch predilatation improve procedural and clinical outcomes in patients undergoing provisional bifurcation PCI for true bifurcation lesions?
Cohort (n=1,042)
Yes
Does side branch predilatation improve procedural and clinical outcomes in patients undergoing provisional bifurcation PCI for true bifurcation lesions?
Absolute Event Rate: 93.7% vs 82.8%
p-value: p=0.003
In provisional bifurcation PCI for true bifurcation lesions, side branch predilatation improves technical and procedural success but increases the likelihood of needing a 2-stent strategy, without significantly affecting in-hospital adverse events.
BACKGROUND: Whether side branch (SB) predilatation should be performed in patients undergoing bifurcation percutaneous coronary interventions (PCI) remains controversial. METHODS: We performed an observational cohort study across six international centers from 2013 to 2024, as part of the Prospective Global Registry of PCI in Bifurcation Lesions (PROGRESS-BIFURCATION). We analyzed procedural characteristics and in-hospital outcomes of patients undergoing provisional bifurcation PCI with and without SB lesion predilatation. Significant SB lesions were defined as those with ≥50% diameter stenosis. Multivariable adjusted hazard ratios (aHR) with 95% confidence intervals [CI] were calculated using mixed effects Cox regression. RESULTS: Of 1042 lesions treated with provisional bifurcation PCI, 428 (41.1%) had significant SB lesions (true bifurcation lesions). Among these, 143 (33.4%) underwent predilatation. Lesions that underwent SB predilatation had longer SB lesion length (median 10.0 mm [IQR 5.0-10.0] vs. 5.0 mm [IQR 5.0-10.0], p = 0.001) and more SB diameter stenosis (median 90% [IQR 70%-95%] vs. 70% [IQR 60-90]). Technical success (95.1% vs. 87.7%; p = 0.015) and procedural success (93.7% vs. 82.8%; p = 0.003) were more common in the SB predilatation group, although the rates of crossover to a 2-stent technique were also higher in the SB predilatation group (23.1% vs. 10.9%; p < 0.001). The incidence of procedural complications (22.3% vs. 21.3%, p = 0.897) and in-hospital major adverse cardiovascular events (2.4% vs. 6.4%, p = 0.097) was similar between the groups. CONCLUSION: In provisional bifurcation PCI of true bifurcation lesions, SB predilatation was performed in approximately one-third and was associated with higher technical and procedural success, higher rates to crossover to a 2-stent technique, and similar incidence of in-hospital and long-term follow-up outcomes.
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Carvalho et al. (2025) conducted a cohort in Bifurcation lesions undergoing percutaneous coronary intervention (n=1,042). Side branch predilatation vs. No side branch predilatation was evaluated on Procedural success (p=0.003). Side branch predilatation during provisional bifurcation PCI was associated with higher procedural success (93.7% vs. 82.8%; p=0.003) but similar in-hospital MACE (2.4% vs. 6.4%; p=0.097).
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