Impact of Side Branch Predilatation on Provisional Bifurcation Percutaneous Coronary Intervention Outcomes: Insights From PROGRESS-BIFURCATION Registry

Abstract

Background: Whether side branch (SB) predilatation should be performed in patients undergoing bifurcation percutaneous coronary interventions (PCI) remains controversial. Methods: We performed an observational cohort study across six international centers from 2013 to 2024, as part of the Prospective Global Registry of PCI in Bifurcation Lesions (PROGRESS-BIFURCATION). We analyzed procedural characteristics and in-hospital outcomes of patients undergoing provisional bifurcation PCI with and without SB lesion predilatation. Significant SB lesions were defined as those with >= 50% diameter stenosis. Multivariable adjusted hazard ratios (aHR) with 95% confidence intervals [CI] were calculated using mixed effects Cox regression. Results: Of 1042 lesions treated with provisional bifurcation PCI, 428 (41.1%) had significant SB lesions (true bifurcation lesions). Among these, 143 (33.4%) underwent predilatation. Lesions that underwent SB predilatation had longer SB lesion length (median 10.0 mm [IQR 5.0-10.0] vs. 5.0 mm [IQR 5.0-10.0], p = 0.001) and more SB diameter stenosis (median 90% [IQR 70%-95%] vs. 70% [IQR 60-90]). Technical success (95.1% vs. 87.7%; p = 0.015) and procedural success (93.7% vs. 82.8%; p = 0.003) were more common in the SB predilatation group, although the rates of crossover to a 2-stent technique were also higher in the SB predilatation group (23.1% vs. 10.9%; p < 0.001). The incidence of procedural complications (22.3% vs. 21.3%, p = 0.897) and in-hospital major adverse cardiovascular events (2.4% vs. 6.4%, p = 0.097) was similar between the groups. Conclusion: In provisional bifurcation PCI of true bifurcation lesions, SB predilatation was performed in approximately one-third and was associated with higher technical and procedural success, higher rates to crossover to a 2-stent technique, and similar incidence of in-hospital and long-term follow-up outcomes.