Impact of Proximal Optimization Technique in Provisional Bifurcation Percutaneous Coronary Intervention: Insights from PROGRESS-BIFURCATION Registry.

The proximal optimization technique (POT) improves proximal main vessel stent expansion and facilitates side-branch access during bifurcation percutaneous coronary intervention (PCI), yet its clinical impact remains unclear. We analyzed data from the PROGRESS-BIFURCATION registry (NCT05100992), a multicenter observational registry including patients treated at 7 centers in the United States, Russia, and Turkey between 2013 and 2025. Procedural characteristics and outcomes were compared between provisional bifurcation PCIs performed with versus without POT. Among 2,679 bifurcation PCIs (2,454 patients), 1,741 procedures (65.0%) were treated with a provisional strategy, of which POT was used in 1,023 procedures (58.8%). Lesions treated with POT were more complex, with higher rates of Medina 1,1,1 anatomy (32.4% vs 15.6%), left main involvement (23.1% vs 14.6%), and severe calcification (15.2% vs 7.7%) (all p <0.001). Bailout 2-stent techniques were more frequently required in the POT group (7.3% vs 3.1%; p = 0.001). POT was associated with higher technical success (95.2% vs 91.9%; p = 0.011) and procedural success (92.4% vs 89.0%; p = 0.039), while in-hospital major adverse cardiac events (MACE) were similar between groups. POT procedures required higher contrast volume and radiation dose but were not associated with longer procedure time. Over a median follow-up of 28.7 months, unadjusted MACE was lower in the POT group (24.2% vs 32.0%; p = 0.011); however, this association was not significant after multivariable adjustment. Individual clinical outcomes, including death, myocardial infarction, stroke, CABG, and target-vessel revascularization, were comparable. In summary, POT was frequently used in complex bifurcation lesions undergoing provisional stenting and was associated with improved procedural success without a clear independent impact on long-term clinical outcomes.