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

Affiliations
  • 1Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. hcgwon@naver.com
  • 2Division of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea.
  • 3Division of Cardiology, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
  • 4Division of Cardiology, Department of Medicine, Seoul National University Hospital, Seoul, Korea.
  • 5Division of Cardiology, Department of Medicine, Chungnam National University Hospital, Daejeon, Korea.

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

  • 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.

  • 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.

  • 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.


Cited by  1 articles

Don't Touch My POT!
Ramesh Daggubati, Kunal Brahmbhatt, Gianluca Rigatelli
Korean Circ J. 2019;49(6):495-497.    doi: 10.4070/kcj.2019.0065.


Reference

1. Lefevre T, Louvard Y. “Everything should be made as simple as possible but not simpler”. Rev Esp Cardiol (Engl Ed). 2018; 71:418–419.
Article
2. Darremont O, Leymarie JL, Lefèvre T, Albiero R, Mortier P, Louvard Y. Technical aspects of the provisional side branch stenting strategy. EuroIntervention. 2015; 11 Suppl V:V86–V90.
Article
3. Mylotte D, Routledge H, Harb T, et al. Provisional side branch-stenting for coronary bifurcation lesions: evidence of improving procedural and clinical outcomes with contemporary techniques. Catheter Cardiovasc Interv. 2013; 82:E437–E445.
4. Dérimay F, Rioufol G, Cellier G, Souteyrand G, Finet G. Benefits of final proximal optimization technique (POT) in provisional stenting. Int J Cardiol. 2019; 274:71–73.
Article
5. Matsuda Y, Ashikaga T, Sasaoka T, et al. Effectiveness of the proximal optimization technique for longitudinal stent elongation caused by post-balloon dilatation. J Interv Cardiol. 2018; 31:624–631.
Article
6. Lassen JF, Holm NR, Banning A, et al. Percutaneous coronary intervention for coronary bifurcation disease: 11th consensus document from the European Bifurcation Club. EuroIntervention. 2016; 12:38–46.
Article
7. Hahn JY, Gwon HC, Kwon SU, et al. Comparison of vessel geometry in bifurcation between normal and diseased segments: intravascular ultrasound analysis. Atherosclerosis. 2008; 201:326–331.
Article
8. Lansky AJ, Dangas G, Mehran R, et al. Quantitative angiographic methods for appropriate end-point analysis, edge-effect evaluation, and prediction of recurrent restenosis after coronary brachytherapy with gamma irradiation. J Am Coll Cardiol. 2002; 39:274–280.
Article
9. Medina A, Suárez de Lezo J, Pan M. A new classification of coronary bifurcation lesions. Rev Esp Cardiol. 2006; 59:183.
Article
10. Mintz GS, Nissen SE, Anderson WD, et al. American College of Cardiology clinical expert consensus document on standards for acquisition, measurement and reporting of intravascular ultrasound studies (IVUS). A report of the American College of Cardiology Task Force on clinical expert consensus documents. J Am Coll Cardiol. 2001; 37:1478–1492.
11. Hakim D, Chatterjee A, Alli O, et al. Role of proximal optimization technique guided by intravascular ultrasound on stent expansion, stent symmetry index, and side-branch hemodynamics in patients with coronary bifurcation lesions. Circ Cardiovasc Interv. 2017; 10:e005535.
Article
12. Blasini R, Neumann FJ, Schmitt C, Bökenkamp J, Schömig A. Comparison of angiography and intravascular ultrasound for the assessment of lumen size after coronary stent placement: impact of dilation pressures. Cathet Cardiovasc Diagn. 1997; 42:113–119.
13. Yu CW, Yang JH, Song YB, et al. Long-term clinical outcomes of final kissing ballooning in coronary bifurcation lesions treated with the 1-stent technique: results from the COBIS II Registry (Korean Coronary Bifurcation Stenting Registry). JACC Cardiovasc Interv. 2015; 8:1297–1307.
Full Text Links
  • KCJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr