Volet Corentin, Puricel Serban, Cook Selma T, di Cicco Philippe, Faucherre Yannick, Arroyo Diego, Togni Mario, Cook Stéphane
Cardiology, University & Hospital Fribourg, Fribourg, Switzerland.
Catheter Cardiovasc Interv. 2024 Feb;103(3):417-424. doi: 10.1002/ccd.30961. Epub 2024 Jan 31.
Optimal stent deployment in left main (LM) bifurcation is paramount, and incomplete stent apposition may cause major adverse cardiac events (MACE). Bench studies show that the proximal optimization technique (POT) provides the best stent apposition.
We aimed to investigate the impact of POT on clinical outcomes in patients treated for unprotected LM (ULM) disease at our institution.
We identified 162 patients who underwent percutaneous coronary intervention (PCI) for ULM coronary disease in the Cardio-FR database. Out of these, 99 (61%) had undergone POT, while 63 patients were treated without POT. The primary outcome was the bifurcation-oriented composite endpoint (BOCE) of cardiac death, target-bifurcation myocardial infarction and target-bifurcation revascularization at maximal follow-up.
Mean age was 76 years, and 69% presented with acute coronary syndrome. Mean follow-up was 2.25 years (822 days). The BOCE occurred in 43 (27%) of which 20 (20%) in the POT group and 23 (37%) in the no-POT group (p = 0.009). Cardiac death occurred in 15 (15%) patients in the POT- and 17 (27%) in no-POT group (p = 0.26). Target bifurcation revascularization occurred in 4 (4%) patients in the POT- and 6 (10%) patients in the no-POT group (p = 0.19). POT In the multivariate analysis, POT was the strongest parameter and was associated with BOCE, cardiac death, occurrence of any revascularization and all-cause mortality.
The POT improves clinical outcomes. These findings strongly support the systematic use of POT in patients undergoing ULM-PCI.
左主干（LM）分叉处支架的最佳置入至关重要，支架贴壁不全可能导致主要不良心脏事件（MACE）。体外研究表明，近端优化技术（POT）可实现最佳的支架贴壁。
我们旨在研究POT对我院接受无保护左主干（ULM）疾病治疗患者临床结局的影响。
我们在Cardio-FR数据库中确定了162例因ULM冠状动脉疾病接受经皮冠状动脉介入治疗（PCI）的患者。其中，99例（61%）接受了POT，而63例患者未接受POT治疗。主要结局是最大随访时的心脏死亡、靶分叉心肌梗死和靶分叉血运重建的分叉导向复合终点（BOCE）。
平均年龄为76岁，69%的患者表现为急性冠状动脉综合征。平均随访时间为2.25年（822天）。43例（27%）发生了BOCE，其中POT组20例（20%），非POT组23例（37%）（p = 0.009）。POT组15例（15%）患者发生心脏死亡，非POT组17例（27%）（p = 0.26）。POT组4例（4%）患者发生靶分叉血运重建，非POT组6例（10%）（p = 0.19）。在多变量分析中，POT是最强的参数，与BOCE、心脏死亡、任何血运重建的发生和全因死亡率相关。
POT可改善临床结局。这些发现有力地支持了在接受ULM-PCI的患者中系统使用POT。
