Impact of Isolated Side Branch Lesions on Procedural Techniques and Outcomes of Bifurcation Percutaneous Coronary Intervention

Abstract

BACKGROUND There is limited information on the outcomes of isolated side branch (ISB) lesions in bifurcation percutaneous coronary intervention (PCI).METHODS We examined the clinical, angiographic characteristics, and procedural outcomes of 1,320 bifurcation PCIs in 1,148 patients from 2014 to 2023 from the PROGRESS-BIFURCATION registry. Angiography-based assessment was performed for lesion evaluation.RESULTS Fifty-six lesions (4.2%) were ISB (Medina class 0,0,1). The side branches most commonly involved were the first diagonal (19.6%) and proximal circumflex arteries (19.6%), followed by the first (16.1%) and second (10.7%) obtuse marginal arteries. ISB patients had similar baseline characteristics with the remaining patients, except for prior PCI (61.9% vs 45.4%; P ¼ 0.036). ISB lesions had a median side branch diameter of 2.5 (Q1-Q3: 2.5-3.0) mm, a median lesion length of 8.0 (Q1-Q3: 5.0-10.0) mm, and median stenosis of 90% (Q1-Q3: 80-95). Moderate to severe calcification was detected in 28.6% of the ISB lesions. The most common stenting strategy was inverted provisional (28.6%), followed by side branch stenting only (26.8%), T-stenting (23.2%), and mini-crush (17.8%). Technical success (100% vs 94.9%; P ¼ 0.108), procedural success (97.6% vs 89.9%; P ¼ 0.115), and in-hospital major adverse cardiovascular events (MACE) (2.4% vs 5.2%; P ¼ 0.719) were similar in patients with and without ISB lesions.CONCLUSIONS PCI of ISB lesions was infrequent and was associated with similar success and in-hospital MACE rates compared with non- ISB bifurcation lesions.