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Active Side-Branch Protection Strategy for Culprit Bifurcation Lesion in STEMI Patients: The Multicenter STEMI-BIF
Ahmet Güner1, Ebru Serin2, Regayip Zehir3
1Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye.
Insights
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.
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.
Background:
To date, the best side branch (SB) protection strategy in patients with coronary bifurcation lesions (CBLs)-related ST-segment elevation myocardial infarction (STEMI) has not yet been settled.
Aims:
This study sought to evaluate the clinical outcome of the jailed balloon (JBT) and jailed wire techniques (JWT) for the SB protection strategy in STEMI patients with culprit CBLs.
Methods:
This large-scale multicenter (n = 10) observational retrospective study included STEMI patients with culprit CBLs who underwent PCI with provisional stenting. The primary endpoint was major adverse cardiac events (MACE) as the combination of death from cardiac causes, target vessel myocardial infarction, or clinically driven target lesion revascularization (TLR). Propensity score-matching analysis was performed.
Results:
A total of 1218 consecutive patients (male: 1020 [83.7%], mean age: 57.68 ± 11.76 years) were included in this study. The study cohort was divided into two groups as JBT (n = 196) and JWT (n = 1022). The incidences of the SB intervention (21.4% vs. 36.2%, p < 0.001) and residual stenosis of SB ≥ 70% (23.0% vs. 45.5%, p < 0.001) were significantly lower in the JBT group compared to the JWT group. Whereas procedure time (47.21 ± 17.70 vs. 40.94 ± 13.18 min, p < 0.001) and fluoroscopy time (15.92 ± 9.51 vs. 13.39 ± 6.69 min, p = 0.001) were notably higher in the JBT group than in the JWT group. The risk-adjusted midterm MACE (HR: 0.688, p = 0.200) and clinally driven TLR (HR: 0.566, p = 0.170) did not differ in individuals with culprit CBLs to protect the SB with JBT and the JWT in the propensity-matched cohort.
Conclusion:
The present study suggests that risk-adjusted MACE and TLR rates were comparable between both techniques at midterm follow-up.
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