Deferred Stenting for Side Branch in STEMI Patients Presented by Bifurcation Culprit Lesion

Abstract Background True bifurcation lesions are challenging in some special populations like patients with heavily calcified vessels, unprotected left main, and thrombus-containing lesions. Multiple inflations are known to increase the incidence of no-reflow/slow-flow (NR/SL) during primary PCI. The ideal bifurcation stenting strategy during primary PCI is still obscure. Some studies have shown some benefits for deferred stenting in primary PCI but still this area needs more evidence. In our study, we compared deferred stenting for the side branch during primary PCI versus the complete bifurcation stenting strategy during primary PCI. Methods This is prospective observational study included patients who presented with STEMI due to true bifurcation culprit lesion amenable for two stents technique. Group one included patients with provisional stenting and deferred side branch stenting before hospital discharge. Group two included patients with complete two stents bifurcation technique during primary PCI. The technique used was according to operator discretion while patients with immediate indications for two stents strategy during the primary setting were excluded from our study. The primary outcome was MACE till hospital discharge. Secondary outcomes included angiographic outcomes by the end of the bifurcation technique. Results A total of 60 patients met our inclusion criteria, mean age (58.69±9.61), 31.2% women. Twenty-six patients received deferred stenting for side branch, and 34 received complete two stents bifurcation strategy at the primary PCI setting. MACE to hospital discharge was lower in the deferred stenting group without significant difference (21.62% vs 23.64%, P>0.01] compared with the two-stenting approach during primary PCI. Group I (deferred stenting) had significantly superior angiographic outcomes than group II. As regards TIMI II-III flow, 86.2% of patients achieved it in both main vessel and side branch versus 51.1% in group II, CTFC was 8.1 versus 9.6, and in group I, 78% of patients achieved TMPG II-III, compared to 56.7% in group II. Conclusion Deferred stenting for side branch in primary PCI achieved superior angiographic outcomes in the treatment of true bifurcation lesions. However, there was no significant difference in MACE between both strategies.