title: The impact of side branch predilatation on procedural and long-term clinical outcomes in coronary bifurcation lesions treated by the provisional approach.
abstract: OBJECTIVE
  It is uncertain whether side branch predilatation before main vessel stenting is necessary. We evaluated the effect of side branch predilatation on outcomes in percutaneous coronary intervention for true nonleft main bifurcation determined by the Medina classification using the provisional approach.
  
  
  METHODS
  Target vessel failures (composite of cardiac death, myocardial infarction, or target vessel revascularization) were compared between patients who underwent side branch predilatation (predilatation group, n = 175) and those who did not (nonpredilatation group, n = 662).
  
  
  RESULTS
  Final kissing-balloon inflation (57.1% vs 35.8%; P < .001) was performed more frequently and the cross-over rate to a 2-stent technique (14.9% vs 5.1%; P < .001) was higher in the predilatation group. During a median follow-up of 21 months, the predilatation group had a higher incidence of target vessel failures (14.3% vs 6.8%; P = .002) and target vessel revascularization (12.0% vs 5.6%; P = .003), but not of cardiac death or myocardial infarction compared with the nonpredilatation group. On multivariate analysis, side branch predilatation was associated with a higher occurrence of target vessel failures (adjusted hazard ratio = 2.11; 95% confidence interval, 1.27-3.50; P = .004). These results remained consistent after a propensity score-matched population analysis (for target vessel failures, adjusted hazard ratio = 2.63; 95% confidence interval, 1.09-6.34; P = .0031) and they were also constant among the various subgroups, according to the bifurcation angle, calcification, and diameter stenosis of the side branch.
  
  
  CONCLUSIONS
  Side branch predilatation before main vessel stenting may be associated with an increased risk of repeat revascularization in patients with true nonleft main bifurcation treated by the provisional approach.
  
  
  BACKGROUND
  ClinicalTrials.gov number: NCT00851526.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, South Korea.
authors.forename: Pil Sang
authors.initials: PS
authors.lastname: Song
authors.affiliation: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Young Bin
authors.initials: YB
authors.lastname: Song
authors.affiliation: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Jeong Hoon
authors.initials: JH
authors.lastname: Yang
authors.affiliation: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Joo-Yong
authors.initials: JY
authors.lastname: Hahn
authors.affiliation: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Seung-Hyuk
authors.initials: SH
authors.lastname: Choi
authors.affiliation: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Jin-Ho
authors.initials: JH
authors.lastname: Choi
authors.affiliation: Seoul National University Hospital, Seoul, South Korea.
authors.forename: Bon-Kwon
authors.initials: BK
authors.lastname: Koo
authors.affiliation: Catholic University Kangnam St. Mary's Hospital, Seoul, South Korea.
authors.forename: Ki Bae
authors.initials: KB
authors.lastname: Seung
authors.affiliation: Ulsan University Asan Medical Center, Seoul, South Korea.
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
authors.affiliation: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. Electronic address: hcgwon62@gmail.com.
authors.forename: Hyeon-Cheol
authors.initials: HC
authors.lastname: Gwon
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D057216:Propensity Score; D016896:Treatment Outcome
keywords: Angioplastia coronaria transluminal percutánea; Bifurcation lesion; Lesión en bifurcación; Percutaneous transluminal coronary angioplasty; Predilatación de la rama lateral; Side branch predilatation