Key result
The proximal optimization technique was associated with a lower risk of major adverse cardiac events compared to non-POT in patients with bifurcation lesions (HR 0.34; 95% CI 0.17-0.69; p=0.003).
Why the study?
Data were limited regarding the clinical efficacy of the proximal optimization technique in treating coronary bifurcation lesions.
Does the proximal optimization technique (POT) improve clinical outcomes in patients with coronary bifurcation lesions treated with drug-eluting stents?
Cohort (n=1,191)
Yes
Does the proximal optimization technique (POT) improve clinical outcomes in patients with coronary bifurcation lesions treated with drug-eluting stents?
The proximal optimization technique (POT) improves long-term clinical outcomes in patients with coronary bifurcation lesions with a large side branch, particularly when treated without kissing ballooning.
May support POT to lower MACE in bifurcation lesions; leaves open confirmation by randomized trials.
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.
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Yang et al. (2019) conducted a cohort in Coronary bifurcation lesions (n=1,191). Proximal optimization technique (POT) vs. Non-POT was evaluated on Major adverse cardiac events (cardiac death, myocardial infarction or target lesion revascularization) (HR 0.34, 95% CI 0.17-0.69, p=0.003). The proximal optimization technique was associated with a lower risk of major adverse cardiac events compared to non-POT in patients with bifurcation lesions (HR 0.34; 95% CI 0.17-0.69; p=0.003).
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