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Comparison of Different Side Branch Ballooning Following Provisional Stenting in Coronary Bifurcation Lesion-Related

Cemalettin Akman1,2, Ahmet Güner2, Regayip Zehir3

  • 1Department of Cardiology, Adiyaman University Training and Research Hospital, Turkey.

Angiology
|December 27, 2025
PubMed

Insights

This study compared two stenting techniques for ST-elevation myocardial infarction (STEMI) patients with coronary bifurcation lesions. Both proximal optimization technique-kissing-proximal optimization technique (PKP) and POT-side-POT (PSP) showed similar overall outcomes, but PKP reduced target lesion revascularization in left main cases.

Area of Science:

  • Interventional Cardiology
  • Cardiovascular Medicine
  • Biomedical Engineering

Background:

  • ST-elevation myocardial infarction (STEMI) often involves complex coronary artery lesions.
  • Coronary bifurcation lesions (CBLs) present unique challenges in percutaneous coronary intervention.
  • Provisional stenting (PS) with proximal optimization technique (POT) is a common strategy, with variations like kissing-POT (PKP) and POT-side-POT (PSP).

Purpose of the Study:

  • To retrospectively assess and compare the clinical outcomes of PKP versus PSP techniques in STEMI patients with culprit CBLs after PS.
  • To identify predictors of major adverse cardiac events (MACE) in this patient population.

Main Methods:

  • A large-scale, multicenter retrospective study involving 596 STEMI patients with culprit CBLs treated with either PKP or PSP following PS.
  • Primary endpoint: MACE, defined as cardiac death, target vessel myocardial infarction (TVMI), or clinically driven target lesion revascularization (TLR).
  • Statistical analysis included hazard ratios (HR) and P-values to compare outcomes and identify independent predictors of MACE.

Main Results:

  • Overall mid-term MACE rates were comparable between the PKP and PSP groups (HR: 0.921, P=.461).
  • Significantly lower rates of main vessel-TLR (0% vs 30%, P=.001) and main vessel-TVMI (0% vs 20%, P=.014) were observed in the PKP group specifically for left main bifurcation lesions.
  • Independent predictors of MACE included diabetes mellitus (HR: 2.628, P<.001), high SYNTAX score (HR: 1.081, P<.001), and bifurcation localization (HR: 2.109, P=.014).

Conclusions:

  • In the overall STEMI population with culprit CBLs treated with PS, both PKP and PSP techniques demonstrate comparable mid-term clinical outcomes.
  • The PKP technique may offer a significant advantage in reducing TLR and TVMI in left main bifurcation lesions.
  • Diabetes, high SYNTAX score, and lesion location are critical factors influencing MACE in these patients.

Keywords:
coronary bifurcationmajor adverse cardiac eventsmyocardial infarctionprovisional stentingproximal optimization technique

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