The Effect of Side Branch Pre-dilatation on Long-term Mortality in Patients with Coronary Bifurcation Stenting - European Medical Journal

The Effect of Side Branch Pre-dilatation on Long-term Mortality in Patients with Coronary Bifurcation Stenting

1 Mins
Interventional Cardiology
Dobrin Vassilev,1 *Niya Mileva,1 Panayot Panayotov,1 Gianluca Rigatelli,2 Robert Gil3
  • 1. Medica Cor Hospital, Ruse, Bulgaria
  • 2. Ospedali Riuniti Padova Sud, Padova, Italy
  • 3. National Medical Institute of Internal Affairs and Administration Ministry, Warsaw, Poland
*Correspondence to [email protected]

Mileva has reported a speaker honorarium from Abbott Vascular; and support to attend The European Society of Cardiology Congress 2023 in Barcelona, Spain, from Servier. The other authors have declared no conflicts of interest.

EMJ Int Cardiol. ;11[1]:29-30. DOI/10.33590/emjintcardiol/10304985.
Clinical outcome, coronary bifurcation, percutaneous coronary revascularisation, side branch.

Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.


For more than 20 years, there has been considerable progress in the treatment of coronary bifurcation lesions.1-4 The one-stent technique with proximal optimisation is fundamental in our current philosophy of coronary bifurcation intervention.4 According to the latest European Bifurcation Club (EBC) statements, side branch pre-dilatation (SBPD) is generally not recommended.2-4 SBPD during coronary bifurcation interventions is a technique that is generally not recommended by the latest guidelines and consensus statements. However, the data about the clinical outcomes after SBPD from dedicated studies are surprisingly few. The objective of the current study was to explore the effects of SBPD on all-cause and cardiovascular mortality at long-term follow-up.


All patients with coronary bifurcation lesions treated with percutaneous coronary intervention (PCI) between 2012–2022 were included in the prospective registry. Patients were divided into two groups, depending on performance of SBPD: SBPD performed (SBPD[+]) and SBPD not performed (SBPD[-]). For the current analysis, only patients with stable or unstable angina were included, with follow-up of at least 2 years. Patients with ST elevation myocardial infarction and left main stenosis were excluded. Propensity score matching was performed to equalise the effects of the following characteristics: age, sex, diabetes, smoking, hypertension, dyslipidaemia, renal failure, cancer, chronic obstructive pulmonary disease (COPD), atrial fibrillation, left ventricular ejection fraction, and SYNTAX score. A multivariate analysis of all-cause and cardiac mortality was performed, with SBPD as an independent variable.


A total of 832 patients from the registry covered the criteria for the current analysis. After propensity score matching, 324 matched couples remained, and 648 patients were analysed. The demographic characteristics of SBPD(+) and SBPD(-) were well balanced, with no significant differences between groups. Mean age was 68±10 years, 71% were males, 40% were smokers, 47% had diabetes, 26% had a previous myocardial infarction, 53% a previous PCI, 4% coronary artery bypass surgery, 12% peripheral arterial disease, 13% COPD, 32% renal failure, 23% atrial fibrillation, and left ventricle ejection fraction was of 55±10%. Patients with SBPD(+) had more chronic total occlusions (17% versus 9%; p=0.003), longer lesions (42±21 mm versus 36±20 mm; p<0.001), and more severe side branch stenoses (68%±25% versus 41%±31%; p<0.001). Among true bifurcation stenoses (Medina xx1: 63%; 410/648), 88% were predilated. At follow-up to 100 months (median 58 [interquartile range: 37–78]), 205/648 (32%) died. Mortality among the SBPD(+) group was significantly higher (all-cause for SBP[+] versus SBP [-]: 33% [107/324] versus 30.2% [98/324], respectively; p=0.045; cardiac: 25.3% [82/324] versus 21.6% [70/324], respectively; p=0.028) (Figure 1).

Figure 1: Kaplan–Meier survival curves for all-cause mortality and cardiac mortality in groups with and without side-branch pre-dilatation.
Cum: cumulative; SBPD(-): side-branch pre-dilatation not-performed; SBPD(+): side-branch pre-dilatation performed.

On Cox survival analysis, SBPD(+) was an independent predictor of all-cause mortality (odds ratio: 1.354; confidence interval: 1.003–1.828; p=0.048; with age, mitral regurgitation, left ventricle hypertrophy, pre-PCI troponin, haemoglobin, COPD) and cardiac mortality (odds ratio: 1.512; confidence interval: 1.070–2.136; p=0.019; with age, diabetes, left ventricle hypertrophy, pre-PCI troponin, COPD).


SBPD treatment of coronary bifurcation stenoses results in worse patient survival at up to 8 years following the procedure. It gives better angiographic results, but this did not translate into better clinical outcomes.

Ge Z et al. Coronary bifurcation lesions. Interv Cardiol Clin. 2022;11(4):405-17. Burzotta F et al. European Bifurcation Club white paper on stenting techniques for patients with bifurcated coronary artery lesions. Catheter Cardiovasc Interv. 2020;96(5):1067-79. Burzotta F et al. Percutaneous coronary intervention for bifurcation coronary lesions: the 15th consensus document from the European Bifurcation Club. EuroIntervention, 2021;16(16):1307-17. Albiero R et al. Treatment of coronary bifurcation lesions, part I: implanting the first stent in the provisional pathway. The 16th expert consensus document of the European Bifurcation Club. Eurointervention, 2022;18(5):e362-76.

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