Clinical Outcomes of Proximal Optimization Technique (POT) in Bifurcation Stenting Short title: Impact of proximal optimization technique

Abstract

Background: Optimal deployment of coronary stents in a bifurcation lesion remains a matter of debate.

Aims: We sought to capture the daily practice of bifurcation stenting by means of a worldwide registry and to investigate how the post-implantation deployment techniques influence the clinical outcomes.

Methods: Data from the e-ULTIMASTER registry were used to perform an analysis of 4395 patients undergoing percutaneous coronary intervention for bifurcation lesions. Inverse probability of treatment weights (IPTW) propensity score methodology was used to adjust for any baseline differences. The primary outcome of interest was target lesion failure (TLF) at 1-year (follow-up rate 96.2%).

Results: Global one-year TLF rate was low: 5.1%. Proximal optimization technique was used in 33.9 % of cases and was associated with a reduction in adjusted TLF rate [4.0 (95% confidence interval:3.0-5.1)% versus 6.0(5.1-6.9)%, p<0.01] due to a reduction of all components of this composite endpoint, except for cardiac death. Stent thrombosis was also positively impacted [0.4(0.04-0.7)% versus 1.3(0.8-1.7)%, p<0.01]. POT benefit was uniform across subgroups. Conversely, the use of kissing balloon technique (36.5%) did not influence the adjusted TLF rate.

Conclusions: Despite a low one-year failure rate in this large bifurcation stenting cohort, proximal optimization technique was associated with a further reduction in the event rate and a uniform benefit across subgroups suggesting systematic use of this deployment technique regardless of the bifurcation anatomy and stenting technique.