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Clinical outcomes after final kissing balloon inflation compared with no final kissing balloon inflation in bifurcation lesions treated with a dedicated coronary bifurcation stent
  1. Maik J Grundeken1,
  2. Maciej Lesiak2,
  3. Solomon Asgedom3,
  4. Eulogio Garcia4,
  5. Armando Bethencourt5,
  6. Michael S Norell6,
  7. Peter Damman1,
  8. Pier Woudstra1,
  9. Karel T Koch1,
  10. M Marije Vis1,
  11. Jose P Henriques1,
  12. Jan G Tijssen1,
  13. Yoshinobu Onuma7,
  14. David P Foley3,
  15. Antonio L Bartorelli8,
  16. Pieter R Stella9,
  17. Robbert J de Winter1,
  18. Joanna J Wykrzykowska1
  1. 1Department of Cardiology, Academic Medical Center—University of Amsterdam, Amsterdam, The Netherlands
  2. 2The 1st Department of cardiology, Poznan University of Medical Sciences, Poznan, Poland
  3. 3Department of Cardiology, Beaumont Hospital, Dublin, Ireland
  4. 4Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
  5. 5Department of Cardiology, Hospital Son Espases, Palma de Mallorca, Spain
  6. 6The Heart and Lung Centre, Wolverhampton Hospital NHS Trust, Wolverhampton, UK
  7. 7Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
  8. 8Department of Cardiovascular Sciences, Centro Cardiologico Monzino, University of Milan, Milan, Italy
  9. 9Department of Cardiology, University Medical Center Utrecht—Utrecht University, Utrecht, The Netherlands
  1. Correspondence to Joanna J Wykrzykowska, Department of Cardiology, B2-127, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands; j.j.wykrzykowska{at}


Objective We evaluated differences in clinical outcomes between patients who underwent final kissing balloon inflation (FKBI) and patients who did not undergo FKBI in bifurcation treatment using the Tryton Side Branch Stent (Tryton Medical, Durham, North Carolina, USA).

Methods Clinical outcomes were defined as target vessel failure (composite of cardiac death, any myocardial infarction and clinically indicated target vessel revascularisation), cardiac death, myocardial infarction (MI), clinically indicated target vessel revascularisation and stent thrombosis. Cumulative event rates were estimated using the Kaplan-Meier method. A multivariable logistic regression analysis was performed to evaluate which factors were potentially associated with FKBI performance.

Results Follow-up data was available in 717 (96%) patients with a median follow-up of 190 days. Cardiac death at 1 year occurred more often in the no-FKBI group (1.7% vs 4.6%, respectively, p=0.017), although this difference was no longer observed after excluding patients presenting with ST segment elevation MI (1.6% vs 3.3%, p=0.133). No significant differences were observed concerning the other clinical outcomes. One-year target vessel failure rates were 10.1% in the no-FKBI group and 9.2% in the FKBI group (p=0.257). Multivariable logistic regression analysis identified renal dysfunction, ST segment elevation MI as percutaneous coronary intervention indication, narrow (<30°) bifurcation angle and certain stent platforms as being independently associated with unsuccessful FKBI.

Conclusions A lower cardiac death rate was observed in patients in whom FKBI was performed compared with a selection of patients in whom FKBI could not be performed, probably explained by an unbalance in the baseline risk profile of the patients. No differences were observed regarding the other clinical outcomes.

  • Coronary Artery Disease
  • Interventional Cardiology

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