Predictors of Side Branch Compromise After Provisional Stenting in Coronary Bifurcation PCI: Clinical and Angiographic Insights from a Tertiary Care Population.
DOI:
https://doi.org/10.58889/PJCVI.6.1.36.49Keywords:
Coronary Bifurcation Lesions, Percutaneous Coronary Intervention, Provisional Stenting, Side Branch Compromise, Diabetes Mellitus, Hypertension, Smoking, Calcification, Acute Coronary SyndromeAbstract
Background: Coronary bifurcation lesions account for 15–20% of percutaneous coronary interventions (PCI) and remain technically challenging. Provisional stenting is the recommended default strategy, yet side branch compromise (SBC) occurs frequently, potentially leading to periprocedural myocardial infarction (MI), impaired coronary perfusion, stent thrombosis, and adverse outcomes. Patients with diabetes, hypertension, or smoking-related vascular disease may be particularly susceptible. This study aimed to determine the frequency of SBC after provisional bifurcation PCI and identify clinical and angiographic predictors, focusing on diabetes, hypertension, and smoking.
Methodology: We conducted a retrospective observational study at the Department of Cardiology, Lady Reading Hospital, Peshawar, Pakistan, including consecutive patients undergoing provisional bifurcation PCI from January to June 2025. Clinical, procedural, and angiographic data were extracted from hospital records. SBC was defined as post-procedural TIMI flow <3 in the side branch.
Results: Among 400 patients (mean age 58 ± 10 years; 71.5% male), diabetes was present in 43.2%, hypertension in 59.8%, current smoking in 31.8%, and acute coronary syndrome in 29.2%. SBC occurred in 82 patients (20.5%, 95% CI 16.6–24.9%). Periprocedural MI was more frequent with SBC than without (22.0% vs. 4.4%, p<0.001). Independent predictors included moderate-to-severe calcification, smoking, diabetes, acute coronary syndrome, hypertension, pre-procedural TIMI 2 flow, side branch lesion length and ostial stenosis, and bifurcation angle. The predictive model demonstrated excellent discrimination (AUC = 0.999).
Conclusion: SBC affected one-fifth of patients undergoing provisional bifurcation PCI. Both clinical (smoking, diabetes, hypertension) and angiographic factors significantly predicted risk. Pre-procedural risk assessment integrating these factors may optimize procedural planning and improve outcomes.
