Corrected Bifurcation Angle versus Distal Bifurcation Angle for Prediction of Side Branch Compromise after Provisional Bifurcation Coronary Intervention

Abstract

Provisional bifurcation percutaneous coronary intervention (PCI) is recommended over two stent strategy but with the risk of side branch (SB) compromise. Prediction SB compromise is crucial for optimizing of the procedure outcome. Neglecting the proximal bifurcation angle (BA), the distal BA was presented as a reliable predictor of SB compromise supposing that the main vessel is always a straight vessel. However, its impact on the fate of side branch is debated. This study aims to compare the corrected BA, the sum of proximal and distal BAs, and the distal BA in terms of prediction of SB compromise. This prospective cohort study was conducted in Zagazig university hospitals in the duration between March 2019 and March 2020 and involved 185 patients who underwent provisional bifurcation PCI. Patients were divided according to the corrected BA into two groups; straight bifurcation model group which involved 73 patients with corrected BA = 180°, and wide bifurcation model group which involved 112 patients with corrected BA > 180°. Compared to the wide bifurcation model, the incidence of SB compromise was substantially higher in the straight bifurcation model (52.1% vs. 15.2%; P < 0.001). The corrected BA had a better area under the curve compared to the distal BA with statistically significant difference (0.711 vs. 0.580; P = 0.023). Multivariate analysis demonstrated that the corrected BA was among the independent predictors of SB compromise. The study concluded that the corrected BA could be a novel strong predictor of SB compromise after provisional bifurcation PCI for future verification.