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Whether side branch (SB) predilation before main vessel (MV) stenting is beneficial is uncertain. We investigated the effects of SB predilation on procedural and long-term outcomes in coronary bifurcation lesions treated using the provisional approach.
A total of 1,083 patients with true bifurcation lesions undergoing percutaneous coronary intervention were evaluated. The primary outcome was a major adverse cardiovascular event (MACE): cardiac death, myocardial infarction, or target lesion revascularization.
SB predilation was performed in 437 (40.4%) patients. Abrupt (10.5% vs. 11.3%; P=0.76) or final SB occlusion (2.7% vs. 3.9%; P=0.41) during the procedure showed no differences between the predilation and non-predilation groups. The angiographic success was significantly higher (69.1% vs. 52.9%, P<0.001), and an SB stent was more frequently implanted (28.4% vs. 14.7%, P<0.001) in the predilation group. During a median follow-up of 36 months, we found no significant difference between the groups in the rate of MACE (11.7% vs. 9.1%; P=0.58). In a propensity score-matched population, the rate of MACE was also similar between the two groups (11.2% vs. 10.2%; P=0.90). In the subgroup analysis, patients with a minimal luminal diameter of the parent vessel less than or equal to 1mm benefited from SB predilation in terms of preventing abrupt SB occlusion (P for interaction = 0.04).
For the treatment of true bifurcation lesion, SB predilation does not improve acute and long-term outcomes, but it can be beneficial in selected patients.
CORONARY: Angioplasty Overview and Outcomes