Impact of Proximal Optimization Technique in Provisional Bifurcation Percutaneous Coronary Intervention: Insights From the PROGRESS-BIFURCATIONS Registry

Authors

• Harmanpreet Kaur
• Pedro Emanuel De Paula Carvalho
• Michaella Alexandrou
• Dimitrios Strepkos
• Athanasios Rempakos, Corewell Health East Resident
• Ali Karagoz II
• Dmitrii Khelimskii
• Mahmut Uluganyan
• Korhan Soylu
• Ufuk Yildirim
• Eleni Kladou
• Barkin Kultursay
• Oleg Krestianinov
• Olga Mastrodemos
• Noah N. Williford
• Bavana V. Rangan
• Konstantinos Voudris
• Yader Sandoval
• Emmanouil S. Brilakis

Document Type

Conference Proceeding

Publication Date

4-7-2026

Publication Title

Journal of the American College of Cardiology

Abstract

BACKGROUND The proximal optimization technique (POT) optimizes stent expansion and side branch access in bifurcation percutaneous coronary intervention (PCI), but its clinical impact in provisional bifurcation PCI remains unclear. METHODS We conducted a multicenter cohort study using the PROGRESS-BIFURCATION registry (NCT05100992), including patients from seven centers in the United States, Russia, and Turkey (2013-2025). Procedural characteristics and clinical outcomes of bifurcation PCI were compared between procedures performed with and without POT in provisional bifurcation PCI. RESULTS Among 2,454 patients undergoing 2,679 bifurcation PCIs, 1,741 (65.0%) underwent provisional bifurcation PCI. POT was performed in 1,023 (58.8%). Patients in the POT group had similar age but lower left ventricular ejection fraction (52.6 ± 12.4% vs. 54.9 ± 11.3%; p=0.002). Lesions treated with POT were more complex, with higher rates of Medina 1,1,1 anatomy (32.4% vs. 15.6%; p< 0.001), left main disease (23.1% vs. 14.6%; p< 0.001), and severe calcification (15.2% vs. 7.7%). Two-stent techniques were more frequent with POT (7.3% vs. 3.1%; p=0.001). POT was associated with higher technical (95.2% vs. 91.9%; p=0.011) and procedural (92.4% vs. 89.0%; p=0.039) success, while in-hospital MACE was comparable (2.9% vs. 3.9%; p=0.329). POT procedures required higher contrast volume (180 [140-230] vs. 167.5 [125-215] mL; p=0.016) and radiation dose (1.44 [0.89-2.14] vs. 1.17 [0.84-1.83] Gy; p=0.005), with no difference in procedure time (63 [40-101] vs. 60 [40-102] minutes; p=0.961). At a median follow-up of 28.7 months, POT was associated with lower MACE (24.2% vs. 32.0%; p=0.011), but no difference on multivariable analysis (aHR 0.87; 95% CI 0.73-1.79; p=0.57). Incidences of CABG (1.2% vs. 2.9%; p=0.092), death (12.9% vs. 15.8%; p=0.232), stroke (3.0% vs. 3.6%; p=0.650), spontaneous MI (6.9% vs. 7.6%; p=0.703), and target-vessel revascularization (7.9% vs. 8.6%; p=0.712) were not different. CONCLUSION POT was performed in only 58.8% of bifurcation PCIs using the provisional approach. POT is used more in anatomically complex cases and was associated with higher technical and procedural success.

Volume

87

Issue

13 Suppl

First Page

A412

Comments

American College of Cardiology 75th Annual Scientific Session & Expo, March 28-30, 2026, New Orleans, LA

Last Page

A413

Recommended Citation

Kaur H, Carvalho PE, Alexandrou MA, Strepkos D, Rempakos A, Karagoz II A, et al. Impact of proximal optimization technique in provisional bifurcation percutaneous coronary intervention: insights from the PROGRESS-BIFURCATIONS registry. J Am Coll Cardiol. 2026 Apr 7;87(13 Suppl):A412-A413. doi:10.1016/j.jacc.2026.02.1014

DOI

10.1016/j.jacc.2026.02.1014