"Main Vessel-Oriented" Treatment Strategy Versus "Open Side Branch" Treatment Strategy in Acute Coronary Syndrome Patients With Culprit Bifurcation Lesions

Percutaneous coronaryinterventionofbifurcationlesionsisassociatedwithanincreased risk ofcomplicationsinpatientswithacutecoronarysyndrome(ACS). Thestudyaimedto evaluate thein-hospitaloutcomesofpatientswithACSwithculpritbifurcationlesions who weretreatedwitheithera"mainvessel-oriented"(MVO) treatmentstrategyoran "open sidebranch"(OSB) treatmentstrategy. Thisretrospectivestudyincluded575consecutive patientswithACS."MVO" and"OSB" treatmentstrategiesweredefinedasprimary/urgent percutaneouscoronaryinterventionproceduresperformedbyeithertotally ignoring thesidebranch(SB) ortryingtomaintainbothmainvesselandSBopenwith thrombolysis inmyocardialinfarction3flow. Proceduralsuccessandmajorcardiac/cerebrovascular eventsduringhospitalizationwerenoted. MVOandOSBtreatmentstrategies were performedon384and191patients, respectively. Theproceduralsuccessratewas significantly higherintheOSBtreatmentstrategywhereasmajorcardiac/cerebrovascular events ratesweresimilarexceptforthecontrast-inducednephropathyratebeingslightly higher inOSBtreatmentstrategy. Subgroupanalysisrevealedasignificantlyhigherprocedural successrateinOSBtreatmentstrategyiftheSBwaslocatedwithinthebifurcation core, especiallyinthosewherethediameterofSBwas >= 2 mm. Inconclusion, ourresults suggest abetterproceduralresultwithSBprotectionattemptsinpatientswithACSwith a culpritbifurcationlesioniftheSBisoriginatingwithinthebifurcationcoreanditsdiameter is >= 2 mm. MVOtreatmentstrategymaybepreferredinmostcaseswithminorSBs located distanttothebifurcationcorebecauseofthesimilarproceduralsuccess. (c) 2023 Elsevier Inc. Allrightsreserved.(AmJCardiol2023;204:339-344)