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Optimal Strategy for Provisional Side Branch Intervention in Coronary Bifurcation Lesions: 3-Year Outcomes of the
Young Bin Song1, Taek Kyu Park1, Joo-Yong Hahn1
1Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Insights
A conservative approach to provisional side branch intervention in coronary bifurcation lesions demonstrated long-term benefits, reducing target vessel failure compared to aggressive strategies. This finding is crucial for optimizing treatment in complex coronary artery disease.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Criteria for provisional side branch (SB) intervention in coronary bifurcation lesions remain undefined.
- Optimal management strategies for complex coronary bifurcations are an area of active research.
Purpose of the Study:
- To compare the long-term outcomes of conservative versus aggressive strategies for provisional SB intervention in patients with coronary bifurcation lesions.
- To evaluate the impact of different SB intervention criteria on target vessel failure (TVF) at 3-year follow-up.
Main Methods:
- A randomized trial involving 258 patients with large bifurcation lesions.
- Patients were assigned to either a conservative or aggressive SB intervention strategy.
- Target vessel failure (TVF) was defined as cardiac death, myocardial infarction, or target vessel revascularization at 3 years.
Main Results:
- At 3 years, TVF occurred in 11.7% of the conservative group versus 20.8% in the aggressive group (p = 0.049).
- Landmark analysis between 1 and 3 years showed significantly lower TVF in the conservative group (2.6% vs. 12.7%; p = 0.004).
- Crossover to a 2-stent technique independently predicted TVF (HR: 5.42, p < 0.001).
Conclusions:
- A conservative strategy for provisional SB intervention in large bifurcation lesions is associated with superior long-term clinical outcomes.
- These findings suggest that less aggressive SB intervention may be beneficial in managing coronary bifurcation lesions.
- The study provides evidence to guide clinical decision-making in complex coronary bifurcation stenting.
Objectives:
This study compared the long-term follow-up results of conservative versus aggressive strategies for provisional side branch (SB) intervention in coronary bifurcation lesions.
Background:
The appropriate criteria for provisional SB ballooning or stenting have not been established.
Methods:
A total of 258 patients with a large bifurcation lesion were randomized to a conservative or aggressive SB intervention strategy. Different criteria applied for the initiation of SB intervention after main vessel stenting in the conservative and aggressive groups were Thrombolysis In Myocardial Infarction flow grade lower than 3 versus a stenosis diameter >75% for non-left main bifurcations, and a stenosis diameter >75% versus a stenosis diameter >50% for left main bifurcations. The primary endpoint was target vessel failure (TVF), defined as a composite of cardiac death, spontaneous myocardial infarction, or target vessel revascularization at 3 years.
Results:
At 3 years, TVF occurred in 11.7% of the conservative group versus 20.8% of the aggressive group (p = 0.049). Although no significant differences were observed in the incidence of TVF between groups at 1 year (9.4% vs. 9.2%; p = 0.97), landmark analysis between 1 and 3 years showed significantly less TVF in patients assigned to the conservative strategy (2.6% vs. 12.7%; p = 0.004). The crossover to the 2-stent technique was an independent predictor of TVF (hazard ratio: 5.42, 95% confidence interval: 2.03 to 14.5; p < 0.001). There was no interaction between left main bifurcation and treatment effects for TVF (p for interaction = 0.8).
Conclusions:
A conservative strategy compared with an aggressive strategy for provisional SB intervention is associated with long-term benefits for patients with a large bifurcation lesion. (Optimal Strategy for Side Branch Stenting in Coronary Bifurcation Lesion; NCT00794014).
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