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

Abstract

Background: There is limited information on the impact of the isolated side branch lesions (ISBL) on the procedural techniques and outcomes of bifurcation percutaneous coronary intervention (PCI). Aims: To examine the clinical, procedural and long-term outcomes of ISBL. Methods: We examined the clinical, angiographic characteristics, and procedural outcomes of 1719 bifurcation PCIs in 1501 patients between 2014 and 2023 from the PROGRESS-BIFURCATION registry. A propensity score matched (PSM) Cox proportional hazards model was used to assess long-term outcomes. Results: ISBL (Medina class 0,0,1) was present in 80 patients (5.3%). ISBL patients had similar baseline characteristics to the remaining patients, except for hypertension (90.0% vs. 79.2%, p = 0.020), prior PCI (66.3% vs. 44.5%, p < 0.001), and prior MI (50.6% vs. 35.2%, p = 0.006) that were more common in ISBL patients. ISBL had a median side branch diameter of 2.5 mm (interquartile range [IQR] 2.5-3.0), a median length of 10 mm (IQR 5-12), and a median side branch stenosis of 90% (IQR 80-95). The most common stenting strategies were side branch stenting (41.8%) and inverted provisional (25.5%). Technical and procedural success and in-hospital major adverse cardiovascular events (MACE) were similar in patients with and without ISBL. At 3-year follow-up, the incidence of MACE was higher in ISBL patients (36.3% vs. 26.4%, p = 0.043), driven by higher repeat target vessel PCI (26.8% vs. 12.0%; p = 0.003). On PSM adjusted Cox analysis, ISBL were independently associated with higher follow-up MACE (hazard ratio 1.58, 95% confidence intervals 1.13-2.20, p = 0.008). Conclusions: PCI of ISBL was infrequent and was associated with similar technical and procedural success with non-ISBL but higher long-term MACE driven by higher TVR.