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Active Side-Branch Protection Strategy for Culprit Bifurcation Lesion in STEMI Patients: The Multicenter STEMI-BIF

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The jailed balloon technique (JBT) and jailed wire technique (JWT) for side branch protection in ST-elevation myocardial infarction (STEMI) patients with coronary bifurcation lesions (CBLs) showed comparable midterm outcomes. Major adverse cardiac events and target lesion revascularization rates did not significantly differ between the two strategies.

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AMI‐acute myocardial infarction/STEMICAD‐coronary artery diseasePCIC‐percutaneous coronary interventionPPCI ‐ primary PCI

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Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Medical Technology

Background:

  • Optimal side branch (SB) protection in ST-elevation myocardial infarction (STEMI) patients with coronary bifurcation lesions (CBLs) remains undetermined.
  • This study addresses the clinical outcomes of two SB protection strategies: jailed balloon technique (JBT) and jailed wire technique (JWT).

Purpose of the Study:

  • To compare the clinical outcomes of JBT versus JWT for SB protection in STEMI patients with culprit CBLs undergoing percutaneous coronary intervention (PCI).
  • To evaluate major adverse cardiac events (MACE) and target lesion revascularization (TLR) rates between the two techniques.

Main Methods:

  • A large-scale, multicenter, observational retrospective study involving 1218 STEMI patients with culprit CBLs treated with PCI and provisional stenting.
  • Propensity score-matching analysis was used to compare outcomes between the JBT (n=196) and JWT (n=1022) groups.
  • Primary endpoint was MACE (cardiac death, target vessel MI, or clinically driven TLR).

Main Results:

  • The JBT group showed significantly lower rates of SB intervention and residual SB stenosis compared to the JWT group.
  • Procedure and fluoroscopy times were longer in the JBT group.
  • Risk-adjusted midterm MACE and clinically driven TLR rates were comparable between the JBT and JWT groups in the propensity-matched cohort.

Conclusions:

  • Both jailed balloon technique (JBT) and jailed wire technique (JWT) offer comparable midterm clinical outcomes for SB protection in STEMI patients with CBLs.
  • The choice between JBT and JWT may depend on specific procedural factors rather than significant differences in midterm MACE or TLR.