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

Abstract

BACKGROUND: Whether side branch (SB) predilation should be performed in patients undergoing bifurcation percutaneous coronary intervention (PCI) remains controversial.METHODS: We performed a retrospective, observational cohort study across 6 international centers from 2013 to 2024 as part of PROGRESSBIRFURCATION(Prospective Global Registry of Percutaneous Coronary Intervention in Bifurcation Lesions). We analyzed procedural characteristics and in-hospital outcomes of patients undergoing provisional bifurcation PCI with and without predilation of SB lesions. Significant SB lesions were defined as those with 50% diameter stenosis. RESULTS Of 929 lesions treated with provisional bifurcation PCI, 379 (40.8%) had significant SB lesions. Among these, 123 (32.4%) underwent predilation. Lesions that underwent SB predilation had longerSB lesion length (median ¼ 10.0 mm [Q1-Q3: 5.0-10.0 mm] vs 5.0 mm [Q1-Q3: 5.0-10.0 mm]; P ¼ 0.001) and more SB diameter stenosis (median ¼ 90% [Q1-Q3: 70%-95%] vs 80% [Q1-Q3: 60-90]). Technical success (95.1% vs 89.5%; P ¼ 0.07) and procedural success (94.4% vs 88.3%; P ¼ 0.08) were more common in the SB predilation group,although these differences did not reach statistical significance. The incidence of procedural complications (14.7% vs 14.3%; P ¼ 0.94) and in-hospital major adverse cardiovascular events (3.4% vs 5.8%; P ¼ 0.35) was similar between the groups (Figure).CONCLUSION In provisional bifurcation PCI, SB predilation is performed in approximately one-third of SB lesions but was not associated with different technical success or major adverse cardiac events.