SOLACI | Latin American Society of Interventional Cardiology

Proximal optimization technique (POT) has been recommended as a standard strategy in bifurcation lesions because it facilitates proper stent implantation and apposition in the proximal main vessel, according to the European Bifurcation Club.

Percutaneous coronary intervention (PCI) of the unprotected left main coronary artery (LMCA) has specific characteristics, and the long-term impact of this strategy has not been evaluated on follow-up.

Researchers conducted an analysis of 162 patients who underwent unprotected LMCA PCI. Of those, 99 (61.1%) underwent the POT, while 63 completed the procedure without POT.

The primary endpoint was a bifurcation-oriented composite of events (PEP BOCE) that included cardiac death, target-bifurcation infarction (TBI), and target-bifurcation- revascularization (TBR).

The mean age was 75 years, and 75% of subjects were men. Overall, 19% had diabetes, 67% had hypertension and 47% had undergone previous PCI.

Additionally, 89% had acute coronary syndrome, while silent ischemia and stable chronic syndromes were less frequent. Ejection fraction was 48%.

About 39% of the cases were true bifurcations. Femoral access was used in 81% of cases, and the use of intracoronary imaging was low (16% for optical coherence tomography [OCT] and 1% for intravascular ultrasound [IVUS]).

At the 5-year follow-up, the PFP BOCE favored those who underwent the POT (20% vs. 37%, hazard ratio [HR]: 0.42 [0.22-0.80], p=0.009). There was no difference in cardiac mortality, TBI or TBR, as well as in stent thrombosis. The need for any revascularization was greater in those who did not undergo the POT (25% vs. 32%, p=0.008).

In the multivariate analysis, the use of POT was a strong predictor of BOCE, cardiac death, need for any revascularization, and non-cardiac death.

Conclusion

The POT improves evolution. These findings strongly support the routine use of POT in patients undergoing unprotected LMCA PCI.