Final kissing balloon dilatation in patients with coronary bifurcation lesions treated with an upfront provisional stenting strategy

Background: The impact of final kissing balloon inflation (FKB) in patients treated with an upfront provisional strategy for coronary bifurcation lesions is controversial. Aims: We aimed to assess the impact of FKB on patient- and lesion-oriented outcomes in a large real-world cohort. Methods: The ULTRA-BIFURCAT registry was obtained by patient-level merging the BIFURCAT and ULTRA registries. Pairs of patients were generated with propensity score matching (PSM). The primary outcome of interest was major adverse cardiac events (MACE) - a composite of all-cause death, myocardial infarction (MI), target lesion revascularisation (TLR) or stent thrombosis. A lesion-oriented composite outcome (LOCO) - a composite of target vessel MI (TVMI) or TLR - along with each single component of MACE represented the secondary outcomes. Subgroup analyses included the site of bifurcation (unprotected left main [ULM] vs non-ULM), side branch involvement (true bifurcation vs non-true bifurcation), side branch diameter and lesion length. Follow-up was censored at 800 days. Results: A total of 5,607 patients undergoing a provisional stenting technique were selected for the present analysis. PSM generated 1,784 pairs. Between the matched patients with FKB versus no FKB, no significant difference in MACE was observed (9.0% vs 8.6%; p=0.68). FKB was associated with a lower rate of the LOCO (1.9% vs 2.9%; p=0.04) compared to the no FKB group, driven by lower rates of TVMI (0.2% vs 0.5%; p=0.03) and TLR (1.8% vs 2.6%; p=0.14). These results were confirmed in the subgroups of patients treated for bifurcations with side branches with a diameter >2.5 mm and for true coronary bifurcation lesions. Conclusions: Among patients treated for coronary bifurcation lesions with provisional stenting, FKB had no significant impact on MACE but was associated with a mild reduction in the incidence of the LOCO.