The proximal optimization technique improves clinical outcomes when treated without kissing ballooning in patients with a bifurcation lesion

Jeong Hoon Yang, Joo Myung Lee, Taek Kyu Park, Young Bin Song, Joo Yong Hahn, Jin Ho Choi, Seung Hyuk Choi, Cheol Woong Yu, Woo Jung Chun, Ju Hyeon Oh, Bon Kwon Koo, Jin Ok Jeong, Hyo Soo Kim, Hyeon Cheol Gwon

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background and Objectives: There are limited data regarding the clinical efficacy of the proximal optimization technique (POT) in the treatment of coronary bifurcation lesions. We investigated the influence of POT on the clinical outcomes of patients with coronary bifurcation lesions. Methods: We enrolled a total of 1,191 patients with a bifurcation lesion with a side branch (SB) diameter ≥2.5 mm treated with a drug-eluting stent from 18 centers between January 2003 and December 2009. The primary outcome was major adverse cardiac events (MACEs: cardiac death, myocardial infarction or target lesion revascularization [TLR]). We performed one-to-many (1:N) propensity score matching with non-fixed matching ratio. Results: POT was performed in 252 patients. During follow-up (median 37 months), the incidence of MACE was lower in the POT group than it was in the non-POT group (adjusted hazard ratio, 0.43; 95% confidence interval [CI], 0.24-0.79; p=0.006). After propensity score matching, these were 0.34; 95% CI, 0.17-0.69; p=0.003 for MACE and 0.37; 95% CI, 0.17-0.78; p=0.01 for TLR. The use of POT was associated with significantly lower TLR in patients treated without kissing ballooning, but was not in those who underwent kissing ballooning (p for interaction=0.03). Conclusions: In coronary bifurcation lesions with a large SB, POT may be beneficial to improve long-term clinical outcome, particularly in patients treated without kissing ballooning during the procedure.

Original languageEnglish
Pages (from-to)485-494
Number of pages10
JournalKorean Circulation Journal
Volume49
Issue number6
DOIs
Publication statusPublished - 2019 Jan 1

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Propensity Score
Confidence Intervals
Drug-Eluting Stents
Myocardial Infarction
Incidence
Therapeutics

Keywords

  • Coronary artery disease
  • Drug-eluting stents
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

The proximal optimization technique improves clinical outcomes when treated without kissing ballooning in patients with a bifurcation lesion. / Yang, Jeong Hoon; Lee, Joo Myung; Park, Taek Kyu; Song, Young Bin; Hahn, Joo Yong; Choi, Jin Ho; Choi, Seung Hyuk; Yu, Cheol Woong; Chun, Woo Jung; Oh, Ju Hyeon; Koo, Bon Kwon; Jeong, Jin Ok; Kim, Hyo Soo; Gwon, Hyeon Cheol.

In: Korean Circulation Journal, Vol. 49, No. 6, 01.01.2019, p. 485-494.

Research output: Contribution to journalArticle

Yang, JH, Lee, JM, Park, TK, Song, YB, Hahn, JY, Choi, JH, Choi, SH, Yu, CW, Chun, WJ, Oh, JH, Koo, BK, Jeong, JO, Kim, HS & Gwon, HC 2019, 'The proximal optimization technique improves clinical outcomes when treated without kissing ballooning in patients with a bifurcation lesion', Korean Circulation Journal, vol. 49, no. 6, pp. 485-494. https://doi.org/10.4070/kcj.2018.0352
Yang, Jeong Hoon ; Lee, Joo Myung ; Park, Taek Kyu ; Song, Young Bin ; Hahn, Joo Yong ; Choi, Jin Ho ; Choi, Seung Hyuk ; Yu, Cheol Woong ; Chun, Woo Jung ; Oh, Ju Hyeon ; Koo, Bon Kwon ; Jeong, Jin Ok ; Kim, Hyo Soo ; Gwon, Hyeon Cheol. / The proximal optimization technique improves clinical outcomes when treated without kissing ballooning in patients with a bifurcation lesion. In: Korean Circulation Journal. 2019 ; Vol. 49, No. 6. pp. 485-494.
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abstract = "Background and Objectives: There are limited data regarding the clinical efficacy of the proximal optimization technique (POT) in the treatment of coronary bifurcation lesions. We investigated the influence of POT on the clinical outcomes of patients with coronary bifurcation lesions. Methods: We enrolled a total of 1,191 patients with a bifurcation lesion with a side branch (SB) diameter ≥2.5 mm treated with a drug-eluting stent from 18 centers between January 2003 and December 2009. The primary outcome was major adverse cardiac events (MACEs: cardiac death, myocardial infarction or target lesion revascularization [TLR]). We performed one-to-many (1:N) propensity score matching with non-fixed matching ratio. Results: POT was performed in 252 patients. During follow-up (median 37 months), the incidence of MACE was lower in the POT group than it was in the non-POT group (adjusted hazard ratio, 0.43; 95{\%} confidence interval [CI], 0.24-0.79; p=0.006). After propensity score matching, these were 0.34; 95{\%} CI, 0.17-0.69; p=0.003 for MACE and 0.37; 95{\%} CI, 0.17-0.78; p=0.01 for TLR. The use of POT was associated with significantly lower TLR in patients treated without kissing ballooning, but was not in those who underwent kissing ballooning (p for interaction=0.03). Conclusions: In coronary bifurcation lesions with a large SB, POT may be beneficial to improve long-term clinical outcome, particularly in patients treated without kissing ballooning during the procedure.",
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T1 - The proximal optimization technique improves clinical outcomes when treated without kissing ballooning in patients with a bifurcation lesion

AU - Yang, Jeong Hoon

AU - Lee, Joo Myung

AU - Park, Taek Kyu

AU - Song, Young Bin

AU - Hahn, Joo Yong

AU - Choi, Jin Ho

AU - Choi, Seung Hyuk

AU - Yu, Cheol Woong

AU - Chun, Woo Jung

AU - Oh, Ju Hyeon

AU - Koo, Bon Kwon

AU - Jeong, Jin Ok

AU - Kim, Hyo Soo

AU - Gwon, Hyeon Cheol

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background and Objectives: There are limited data regarding the clinical efficacy of the proximal optimization technique (POT) in the treatment of coronary bifurcation lesions. We investigated the influence of POT on the clinical outcomes of patients with coronary bifurcation lesions. Methods: We enrolled a total of 1,191 patients with a bifurcation lesion with a side branch (SB) diameter ≥2.5 mm treated with a drug-eluting stent from 18 centers between January 2003 and December 2009. The primary outcome was major adverse cardiac events (MACEs: cardiac death, myocardial infarction or target lesion revascularization [TLR]). We performed one-to-many (1:N) propensity score matching with non-fixed matching ratio. Results: POT was performed in 252 patients. During follow-up (median 37 months), the incidence of MACE was lower in the POT group than it was in the non-POT group (adjusted hazard ratio, 0.43; 95% confidence interval [CI], 0.24-0.79; p=0.006). After propensity score matching, these were 0.34; 95% CI, 0.17-0.69; p=0.003 for MACE and 0.37; 95% CI, 0.17-0.78; p=0.01 for TLR. The use of POT was associated with significantly lower TLR in patients treated without kissing ballooning, but was not in those who underwent kissing ballooning (p for interaction=0.03). Conclusions: In coronary bifurcation lesions with a large SB, POT may be beneficial to improve long-term clinical outcome, particularly in patients treated without kissing ballooning during the procedure.

AB - Background and Objectives: There are limited data regarding the clinical efficacy of the proximal optimization technique (POT) in the treatment of coronary bifurcation lesions. We investigated the influence of POT on the clinical outcomes of patients with coronary bifurcation lesions. Methods: We enrolled a total of 1,191 patients with a bifurcation lesion with a side branch (SB) diameter ≥2.5 mm treated with a drug-eluting stent from 18 centers between January 2003 and December 2009. The primary outcome was major adverse cardiac events (MACEs: cardiac death, myocardial infarction or target lesion revascularization [TLR]). We performed one-to-many (1:N) propensity score matching with non-fixed matching ratio. Results: POT was performed in 252 patients. During follow-up (median 37 months), the incidence of MACE was lower in the POT group than it was in the non-POT group (adjusted hazard ratio, 0.43; 95% confidence interval [CI], 0.24-0.79; p=0.006). After propensity score matching, these were 0.34; 95% CI, 0.17-0.69; p=0.003 for MACE and 0.37; 95% CI, 0.17-0.78; p=0.01 for TLR. The use of POT was associated with significantly lower TLR in patients treated without kissing ballooning, but was not in those who underwent kissing ballooning (p for interaction=0.03). Conclusions: In coronary bifurcation lesions with a large SB, POT may be beneficial to improve long-term clinical outcome, particularly in patients treated without kissing ballooning during the procedure.

KW - Coronary artery disease

KW - Drug-eluting stents

KW - Percutaneous coronary intervention

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