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Zhang D, Zhao Z, Gao G, Xu H, Wang H, Liu S, Yin D, Feng L, Zhu C, Wang Y, Zhao Y, Yang Y, Gao R, Xu B, Dou K. Jailed Balloon Technique Is Superior to Jailed Wire Technique in Reducing the Rate of Side Branch Occlusion: Subgroup Analysis of the Conventional Versus Intentional StraTegy in Patients With High Risk PrEdiction of Side Branch OccLusion in Coronary Bifurcation InterVEntion Trial. Front Cardiovasc Med 2022; 9:814873. [PMID: 35433861 PMCID: PMC9008226 DOI: 10.3389/fcvm.2022.814873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveJailed balloon technique (JBT) is an active side branch (SB) protection strategy and is considered to be superior to the jailed wire technique (JWT) in reducing SB occlusion. However, no randomized trials have proved that. We aim to investigate whether JBT could decrease the SB occlusion rate.MethodsConventional versus Intentional straTegy in patients with high Risk prEdiction of Side branch OccLusion in coronary bifurcation interVEntion (CIT-RESOLVE) (NCT02644434, registered on December 31, 2015) (https://clinicaltrials.gov) is a randomized trial that assessed the effects of different strategies on SB occlusion rate in patients with a high risk of SB occlusion. The present subgroup analysis enrolled bifurcation lesions (2 mm ≤ reference vessel diameter of SB < 2.5 mm) with Visual estimation for Risk prEdiction of Side branch OccLusion in coronary bifurcation intervention (V-RESOLVE) score ≥ 12 points. The primary endpoint is SB occlusion. One-year clinical events were compared.ResultsA total of 284 subjects at 16 sites were randomly assigned to the JBT group (n = 143) or the JWT group (n = 141). The rate of SB occlusion (9.1 vs. 19.9%, p = 0.02) and periprocedural myocardial infarction (defined by WHO, 7 vs. 14.9%, p = 0.03) is significantly lower in the JBT group than in the JWT group. The JBT and JWT groups showed no significant differences in cardiac death (0.7 vs. 0.7%, p = 1), myocardial infarction (MI, 6.3 vs. 7.1%, p = 0.79), target lesion revascularization (TLR, 1.4 vs. 2.1%, p = 0.68), and major cardiac adverse events (MACE, a composite of all-cause death, MI, or TLR, 8.4 vs. 10.6%, p = 0.52) during a 1-year follow-up.ConclusionIn patients with a high risk of SB occlusion (V-RESOLVE score ≥ 12 points), JBT is superior to JWT in reducing SB occlusion. However, no significant differences were detected in 1-year MACE.
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Affiliation(s)
- Dong Zhang
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Department of Cardiology, National Center for Cardiovascular Diseases, Fu Wai Hospital, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiyong Zhao
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Department of Cardiology, National Center for Cardiovascular Diseases, Fu Wai Hospital, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guofeng Gao
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Department of Cardiology, National Center for Cardiovascular Diseases, Fu Wai Hospital, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Han Xu
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Department of Cardiology, National Center for Cardiovascular Diseases, Fu Wai Hospital, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hao Wang
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Department of Cardiology, National Center for Cardiovascular Diseases, Fu Wai Hospital, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuai Liu
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Department of Cardiology, National Center for Cardiovascular Diseases, Fu Wai Hospital, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dong Yin
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Department of Cardiology, National Center for Cardiovascular Diseases, Fu Wai Hospital, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Feng
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Department of Cardiology, National Center for Cardiovascular Diseases, Fu Wai Hospital, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chenggang Zhu
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Department of Cardiology, National Center for Cardiovascular Diseases, Fu Wai Hospital, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Wang
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China
| | - Yanyan Zhao
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China
| | - Yuejin Yang
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Department of Cardiology, National Center for Cardiovascular Diseases, Fu Wai Hospital, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Runlin Gao
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Department of Cardiology, National Center for Cardiovascular Diseases, Fu Wai Hospital, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Xu
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Catheterization Laboratories, Fu Wai Hospital, Beijing, China
- *Correspondence: Bo Xu,
| | - Kefei Dou
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Department of Cardiology, National Center for Cardiovascular Diseases, Fu Wai Hospital, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Kefei Dou,
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Dou K, Zhang D, Pan H, Guo N, Li L, Li Y, Zhang Q, Liu B, Shen Z, Zhang B, Liu J, Han W, Wang Y, Zhao Y, Yang Y, Chen S, Xie L, Guan C, Kirtane AJ, Xu B. Active SB-P Versus Conventional Approach to the Protection of High-Risk Side Branches: The CIT-RESOLVE Trial. JACC Cardiovasc Interv 2020; 13:1112-1122. [PMID: 32381188 DOI: 10.1016/j.jcin.2020.01.233] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study was to determine whether an active side branch protection (SB-P) strategy is superior to the conventional strategy in reducing side branch (SB) occlusion in high-risk bifurcation treatment. BACKGROUND Accurate prediction of SB occlusion after main vessel stenting followed by the use of specific strategies to prevent occlusion would be beneficial during bifurcation intervention. METHODS Eligible patients who had a bifurcation lesions with high risk for occlusion as determined using the validated V-RESOLVE (Visual Estimation for Risk Prediction of Side Branch Occlusion in Coronary Bifurcation Intervention) score were randomized to an active SB-P strategy group (elective 2-stent strategy for large SBs and jailed balloon technique for small SBs) or a conventional strategy group (provisional stenting for large SBs and jailed wire technique for small SBs) in a 1:1 ratio stratified by SB vessel size. The primary endpoint of SB occlusion was defined as an angiography core laboratory-assessed decrease in TIMI (Thrombolysis In Myocardial Infarction) flow grade or absence of flow in the SB immediately after full apposition of the main vessel stent to the vessel wall. RESULTS A total of 335 subjects at 16 sites were randomized to the SB-P group (n = 168) and conventional group (n = 167). Patients in the SB-P versus conventional strategy group had a significantly lower rate of SB occlusion (7.7% [13 of 168] vs. 18.0% [30 of 167]; risk difference: -9.1%; 95% confidence interval: -13.1% to -1.8%; p = 0.006), driven mainly by the difference in the small SB subgroup (jailed balloon technique vs. jailed wire technique: 8.1% vs. 18.5%; p = 0.01). CONCLUSIONS An active SB-P strategy is superior to a conventional strategy in reducing SB occlusion when treating high-risk bifurcation lesions. (Conventional Versus Intentional Strategy in Patients With High Risk Prediction of Side Branch Occlusion in Coronary Bifurcation Intervention [CIT-RESOLVE]; NCT02644434).
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Affiliation(s)
- Kefei Dou
- State Key Laboratory of Cardiovascular Disease, Beijing, China; Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
| | - Dong Zhang
- State Key Laboratory of Cardiovascular Disease, Beijing, China; Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Hongwei Pan
- Department of Cardiology, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Ning Guo
- Department of Cardiology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lang Li
- Department of Cardiology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yue Li
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qi Zhang
- Department of Cardiology, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Bin Liu
- Department of Cardiology, the Second Hospital of Jilin University, Changchun, China
| | - Zhujun Shen
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Zhang
- Department of Cardiology, Guangdong General Hospital, Guangzhou, China
| | - Jian Liu
- Departments of Cardiology, Peking University People's Hospital, Beijing, China
| | - Wei Han
- Department of Cardiology, the Third Medical Center of the Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yang Wang
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China
| | - Yanyan Zhao
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China
| | - Yuejin Yang
- State Key Laboratory of Cardiovascular Disease, Beijing, China; Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Shaoliang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Lihua Xie
- Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changdong Guan
- Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ajay J Kirtane
- Center for Interventional Vascular Therapy, Columbia University Medical Center/NewYork-Presbyterian Hospital, and the Cardiovascular Research Foundation, New York, New York
| | - Bo Xu
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China; Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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