Procedural characteristics and outcomes of bifurcation percutaneous coronary intervention: Insights from the PROGRESS-BIFURCATION registry

Abstract

BackgroundPerforming bifurcation percutaneous coronary intervention (PCI) can present challenges and requires ongoing adaptation as techniques continually evolve.MethodsWe examined the procedural characteristics and outcomes of 859 bifurcation PCIs performed at five centers between 2014-2023 from the Prospective Global Registry for the Study of Bifurcation Lesion Interventions (PROGRESS-BIFURCATION, NCT05100992).ResultsMean age was 66±11.7 years, 75.6% were men with a high prevalence of comorbidities; hypertension (80%), diabetes mellitus (36%), dyslipidemia (80%). The predominant stenting technique was provisional (67.6%), followed by double-kissing (DK) crush (13.3%), Culotte (4.5%), mini-crush with two stents (3.6%). Lesions treated with planned two stent strategies were more likely to be in the left main (34% vs. 23%, p=0.001), have larger proximal (3.6±0.6 vs. 3.4±0.6 mm, p<0.001), distal (3.1±0.4 vs. 2.9±0.5 mm, p<0.001) and side-branch diameter (2.7±0.4 vs. 2.5±0.5 mm, p<0.001). Planned two stent strategies had longer procedure time, and higher use of intravascular imaging (40% vs. 29%, p=0.001) (Table). Side branch occlusion occurred in 12% of provisional cases, necessitating ballooning in 7.4% and stenting in 4.5%. Overall technical success was 94% and the incidence of in-hospital major adverse cardiovascular events (MACE) was 5.2%.ConclusionsBifurcation PCI showed high technical success and acceptable in-hospital MACE. Provisional stenting is commonly used, and DK crush was the most commonly used two-stent strategy.