Proximal optimization technique and percutaneous coronary intervention for left main disease: POTENTIAL-LM

Area of Science:

• Interventional Cardiology
• Cardiovascular Research
• Medical Device Technology

Background:

• Incomplete stent apposition in left main (LM) bifurcation stenting is a risk factor for major adverse cardiac events (MACE).
• Bench studies indicate the proximal optimization technique (POT) enhances stent apposition.
• Unprotected left main (ULM) coronary disease requires optimal stenting strategies.

Purpose of the Study:

• To evaluate the clinical impact of the proximal optimization technique (POT) in patients with unprotected left main (ULM) disease.
• To assess the effect of POT on bifurcation-oriented composite endpoints (BOCE) after ULM percutaneous coronary intervention (PCI).

Main Methods:

• A retrospective analysis of 162 patients undergoing ULM-PCI was conducted.
• 99 patients were treated with POT, while 63 were treated without POT.
• The primary outcome was the bifurcation-oriented composite endpoint (BOCE) including cardiac death, target-bifurcation myocardial infarction, and target-bifurcation revascularization.

Main Results:

• The BOCE occurred in 20% of patients treated with POT versus 37% in the no-POT group (p=0.009).
• Multivariate analysis identified POT as the strongest predictor for improved BOCE, reduced cardiac death, revascularization, and all-cause mortality.
• Mean follow-up was 2.25 years.

Conclusions:

• The proximal optimization technique (POT) significantly improves clinical outcomes in patients undergoing unprotected left main percutaneous coronary intervention (ULM-PCI).
• These findings support the routine adoption of POT in ULM-PCI procedures.
• POT is associated with better stent deployment and reduced adverse cardiac events.