title: Provisional side branch-stenting for coronary bifurcation lesions: evidence of improving procedural and clinical outcomes with contemporary techniques.
abstract: OBJECTIVE
  To determine whether recent technical modifications have improved clinical outcomes for patients undergoing contemporary bifurcation lesion percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  Provisional side branch (SB)-stenting has become the preferred strategy for bifurcation PCI. Newer generation drug-eluting stents (DESs), the proximal optimization technique (POT), and the use of noncompliant (NC) balloons for final kissing inflation (FKI) have the potential to optimize outcomes.
  
  
  METHODS
  We compared baseline characteristics, procedural and clinical outcomes in 300 consecutive patient pairs treated in 2005 and 2009. The primary outcome measure was the cumulative incidence of major adverse cardiac events (MACE) at 2-years.
  
  
  RESULTS
  Compared to 2005, patients undergoing PCI in 2009 were at higher risk: prior myocardial infarction (18% vs. 8%, P = 0.0004), left ventricular function (EF 54 ± 13% vs. 61 ± 12%, P < 0.0001). Cypher (53 vs. 3%, P < 0.001) and Taxus (47 vs. 11%, P < 0.0001) stents were used more frequently in 2005, and Xience V in 2009 (0 vs. 47%, P < 0.0001). In 2009, the POT was performed in 36% and NC balloons used for FKI in 81%. SB stenting was required less frequently in 2009 (9% vs. 22%, P < 0.001). Two-year MACE was significantly lower in 2009 than 2005 (5.7 vs. 11.3%, P = 0.02), a difference driven by fewer cardiac deaths (2.0 vs. 5.0%, P = 0.05). MACE was independently associated with left main bifurcation treatment [hazard ratio (HR) 1.85:95%, CI 1.04-3.29; P = 0.036], side-branch stenting (HR 2.31:95% CI 1.27-4.20; P = 0.006), and PCI in 2005 (HR 1.86:95% CI 1.03-3.37; P = 0.004).
  
  
  CONCLUSIONS
  Together, contemporary techniques and newer generation DES appear to improve outcomes and are both recommended for widespread uptake in patients undergoing provisional SB stenting for coronary bifurcation lesions.
authors: Institut Cardiovasculaire Paris Sud: Institut Hospitalier Jacques Cartier Massy, and Hopital Claude Galien, Quincy, France.
authors: Darren
authors: D
authors: Mylotte
authors: Helen
authors: H
authors: Routledge
authors: Talal
authors: T
authors: Harb
authors: Philippe
authors: P
authors: Garot
authors: Thomas
authors: T
authors: Hovasse
authors: Hakim
authors: H
authors: Benamer
authors: Thierry
authors: T
authors: Unterseeh
authors: Bernard
authors: B
authors: Chevalier
authors: Marie-Claude
authors: MC
authors: Morice
authors: Yves
authors: Y
authors: Louvard
authors: Thierry
authors: T
authors: Lefèvre
mesh_terms: D000368:Aged; D062906:Cardiac Catheters / Q000639:trends; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D004059:Diffusion of Innovation; D054855:Drug-Eluting Stents / Q000639:trends; D004867:Equipment Design; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000401:mortality / Q000639:trends*; D011474:Prosthesis Design; D012042:Registries; D012307:Risk Factors; D015607:Stents / Q000639:trends*; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left
keywords: coronary bifurcation stenting; percutaneous coronary intervention; provisional side branch-stenting