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. 2021 Dec 3;17(11):e910-e918.
doi: 10.4244/EIJ-D-20-01393.

Clinical outcomes of the proximal optimisation technique (POT) in bifurcation stenting

Bernard Chevalier  1 , Mamas A Mamas, Thomas Hovasse, Muhammad Rashid, Joan Antoni Gómez-Hospital, Manuel Pan, Adam Witkowski, James Crowley, Adel Aminian, John McDonald, Farzin Beygui, Javier Fernandez Portales, Ariel Roguin, Goran Stankovic
Affiliations

Clinical outcomes of the proximal optimisation technique (POT) in bifurcation stenting

Bernard Chevalier et al. EuroIntervention. .

Abstract

Background: Optimal deployment of coronary stents in a bifurcation lesion remains a matter of debate.

Aims: We sought to capture the daily practice of bifurcation stenting by means of a worldwide registry and to investigate how post-implantation deployment techniques influence clinical outcomes.

Methods: Data from the e-ULTIMASTER registry were used to perform an analysis of 4,395 patients undergoing percutaneous coronary intervention for bifurcation lesions. Inverse probability of treatment weights (IPTW) propensity score methodology was used to adjust for any baseline differences. The primary outcome of interest was target lesion failure (TLF) at one year (follow-up rate 96.2%).

Results: The global one-year TLF rate was low (5.1%). The proximal optimisation technique (POT) was used in 33.9% of cases and was associated with a reduction in the adjusted TLF rate (4.0% [95% confidence interval: 3.0-5.1%] vs 6.0% [5.1-6.9%], p<0.01) due to a reduction of all components of this composite endpoint, except for cardiac death. Stent thrombosis was also positively impacted (0.4% [0.04-0.7%] vs 1.3% [0.8-1.7%], p<0.01). POT benefit was uniform across subgroups. Conversely, the use of the kissing balloon technique (36.5%) did not influence the adjusted TLF rate.

Conclusions: Despite a low one-year failure rate in this large bifurcation stenting cohort, POT was associated with a further reduction in the event rate and a uniform benefit across subgroups, suggesting systematic use of this deployment technique regardless of the bifurcation anatomy and stenting technique.

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Conflict of interest statement

B. Chevalier reports grants from Terumo during the conduct of the study, personal fees from Terumo, outside the submitted work, and being a minor shareholder of CERC (CRO). M. Mamas has the following interests to declare: unrestricted educational grants from Terumo, Abbott, Medtronic and Biosensors, and speaker fees from Terumo, Daiichi Sankyo and Biosensors. M. Pan reports minor lecture fees from Abbott, Terumo and Volcano. F.F. Beygui reports grants from Terumo during the conduct of the study, grants and personal fees from Medtronic and Biosensor, and personal fees from Bristol Myers Squibb, outside the submitted work. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow chart of the study population. *The one-year follow-up population includes patients who had an event that contributed to the primary endpoint, died during follow-up or completed one-year follow-up.
Figure 2
Figure 2
Unadjusted one-year clinical outcomes of all bifurcation patients (N=4,230). CD-TLR clinically driven target lesion revascularisation; CD-TVR clinically driven target vessel revascularisation; ST: stent thrombosis; TLF: target lesion failure; TVF: target vessel failure; TV-MI target vessel myocardial infarction
Figure 3
Figure 3
Impact of POT in major angiographic and procedural subgroups - inverse propensity score weighted analysis. DAPT: duel anti platelet therapy; KBT: kissing balloon technique; LAD: left anterior descending coronary artery; POT: proximal optimisation technique
Central illustration
Central illustration
POT versus no POT: inverse propensity score weighted Kaplan-Meier curve of target lesion failure. KM: Kaplan Meier; POT: proximal optimisation technique
See this image and copyright information in PMC

References

    1. Sawaya FJ, Lefevre T, Chevalier B, Garot P, Hovasse T, Morice MC, Rab T, Louvard Y. Contemporary Approach to Coronary Bifurcation Lesion Treatment. JACC Cardiovasc Interv. 2016;9:1861–78. doi: 10.1016/j.jcin.2016.06.056. - DOI - PubMed
    1. Louvard Y, Thomas M, Džavík V, Hildick-Smith D, Galassi AR, Pan M, Burzotta F, Zelizko M, Dudek D, Ludman P, Sheiban I, Lassen JF, Darremont O, Kastrati A, Ludwig J, Iakovou I, Brunel P, Lansky A, Meerkin D, Legrand V, Medina A, Lefevre T. Classification of coronary artery bifurcation lesions and treatments: time for a consensus! Catheter Cardiovasc Interv. 2008;71:175–83. doi: 10.1002/ccd.21314. - DOI - PubMed
    1. Lassen JF, Holm NR, Stankovic G, Lefevre T, Chieffo A, Hildick-Smith D, Pan M, Darremont O, Albiero R, Ferenc M, Louvard Y. Percutaneous coronary intervention for coronary bifurcation disease: consensus from the first 10 years of the European Bifurcation Club meetings. EuroIntervention. 2014;10:545–60. doi: 10.4244/EIJV10I5A97. - DOI - PubMed
    1. Sgueglia GA, Chevalier B. Kissing balloon inflation in percutaneous coronary interventions. JACC Cardiovasc Interv. 2012;5:803–11. doi: 10.1016/j.jcin.2012.06.005. - DOI - PubMed
    1. Hildick-Smith D, Lassen JF, Albiero R, Lefevre T, Darremont O, Pan M, Ferenc M, Stankovic G, Louvard Y European Bifurcation Club. Consensus from the 5th European Bifurcation Club meeting. EuroIntervention. 2010;6:34–8. - PubMed