The Impact of Coronary Bifurcation Angle on Cardiovascular Outcomes in Culotte Stenting Technique: The Insights From the OPTIMUM Trial.

BACKGROUND

Culotte stenting is one of the most preferred techniques in the percutaneous coronary intervention (PCI) of coronary bifurcation lesion (CBL). Therefore, clinical event predictors in culotte stenting are gaining importance. Bifurcation angle (BA) is an important determinant of the clinical outcomes for the PCI of CBL.

AIMS: Our aim in this study was to investigate the impact of BA in culotte stenting technique on cardiovascular outcomes.

METHODS

The OPTIMUM trial was a single-center, observational registry. A total of 1408 PCI procedures were evaluated, and 200 patients were included. Then, patients were divided into two groups according to the BA. 157 patients with BA 70° or less were categorized as group 1, while 43 with BA more than 70° were categorized as group 2. The primary endpoint of the study was the target lesion failure (TLF) which was a composite endpoint of target vessel myocardial infarction (TVMI), target lesion revascularization (TLR) and cardiac death at 1- and 3-year follow-up periods.

RESULTS

The incidence of TLF at 1-year (4 [2.5%]; 4 [9.3%], p = 0.048) and 3-year [14 (8.9%); 10 (23.3%), p = 0.008] were significantly lower in patients with BA 70° or less compared to patients with BA more than 70° that was mainly driven by the TLR at 3-year (10 [6.4%]; 8 [18.6%], p = 0.013). The incidence of TVMI (5 [3.2%]; 2 [4.7%], p = 0.648) and cardiac death (4 [2.5%]; 2 [4.7%], p = 0.458) were similar in both groups at 3-year.

CONCLUSION

The wider BA is associated with increased 3-year TLR and TLF in culotte stenting technique.