Impact of bifurcation angles on clinical outcomes of TAP technique in STEMI

The T-stent and small protrusion (TAP) technique is frequently utilised as a bailout two-stent strategy during provisional bifurcation stenting. However, the impact of bifurcation angle on long-term clinical outcomes following TAP stenting in ST-elevation myocardial infarction (STEMI) remains underexplored.

We retrospectively evaluated 386 STEMI patients who underwent TAP stenting after side branch (SB) compromise. Patients were stratified into three groups based on bifurcation angle: >70° (Group 1), 50-70° (Group 2), and <50° (Group 3). The primary endpoint was target lesion failure (TLF), defined as a composite of cardiac death, target-vessel myocardial infarction, and clinically-driven target lesion revascularization. Cox proportional hazards models were used to assess independent predictors of outcomes.

The primary outcome (TLF) occurred in 13% of patients overall and did not differ significantly among bifurcation angle groups, although numerically higher rates were observed in the narrow angle group. In-hospital myocardial infarction (5.6%) and death (11.1%) were significantly higher in Group 3 (<50°). Cardiac death was significantly more frequent in Group 3 (11.1%; p = 0.02). Independent predictors of TLF included SB stent length, distal left main involvement, and baseline CRP, whereas larger POT balloon size was protective.

TAP stenting appears safe and effective in wide and intermediate bifurcation angles in STEMI. However, narrow angles (<50°) may portend a higher risk of adverse events, warranting cautious application and further validation through prospective studies.