{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T11:07:45Z","timestamp":1785150465850,"version":"3.55.0"},"reference-count":18,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,12,29]],"date-time":"2020-12-29T00:00:00Z","timestamp":1609200000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>We assessed the impact of pre\u2010percutaneous coronary intervention (PCI) bifurcation angle change (BAC) on clinical outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Background<\/jats:title><jats:p>There are little available data about the impact of BAC in unprotected left main distal bifurcation lesions (ULMD) PCI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We identified consecutive 300 patients with ULMD underwent complex stenting using drug\u2010eluting stent in three high\u2010volume centers (Tokyo and Milan). We measured the widest BA of ULMD at both end\u2010diastole and end\u2010systole before stenting with two\u2010dimensional quantitative coronary angiographic assessment and calculated the BAC value as a difference of two BA value in each lesion. We divided them into small and large BAC group according to the median BAC value (7.2\u00b0). The primary endpoint was target lesion failure (TLF), which was defined as a composite of cardiac death, target lesion revascularization (TLR) and myocardial infarction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>TLF rate at 3\u2010year was significantly higher in the large BAC group than in the small BAC group (adjusted hazard ratio [HR] 5.85; 95% confidence interval [CI], 3.40\u201310.1; <jats:italic>p<\/jats:italic>\u00a0&lt;\u2009.001). TLR rate for left main (LM) to left anterior descending artery (LAD) and ostial left circumflex artery (LCXos) at 3\u2010year were significantly higher in large BAC group than in small BAC group (adjusted HR 5.91; 95% CI, 2.03\u201317.2; <jats:italic>p<\/jats:italic>\u00a0=\u2009.001 and adjusted HR 10.6; 95% CI, 5.20\u201321.6; <jats:italic>p<\/jats:italic>\u00a0&lt;\u2009.001, respectively).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A large BAC before stenting is strongly associated with adverse events after complex stenting for ULMD, mainly driven by repeat PCI for restenosis of the LCXos and of the LM\u2010LAD.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ccd.29431","type":"journal-article","created":{"date-parts":[[2020,12,29]],"date-time":"2020-12-29T20:30:44Z","timestamp":1609273844000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Clinical impact of bifurcation angle change between diastole and systole in complex stenting for left main distal bifurcation: The Milan and <scp>New\u2010Tokyo<\/scp> (<scp>MITO<\/scp>) Registry"],"prefix":"10.1002","volume":"98","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4050-0275","authenticated-orcid":false,"given":"Yusuke","family":"Watanabe","sequence":"first","affiliation":[{"name":"Department of Interventional Cardiology San Raffaele Scientific Institute  Milan Italy"},{"name":"Department of Interventional Cardiology New Tokyo Hospital  Matsudo Japan"},{"name":"Department of Interventional Cardiology Maria Cecilia Hospital GVM  Cotignola Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoru","family":"Mitomo","sequence":"additional","affiliation":[{"name":"Department of Interventional Cardiology New Tokyo Hospital  Matsudo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toru","family":"Naganuma","sequence":"additional","affiliation":[{"name":"Department of Interventional Cardiology New Tokyo Hospital  Matsudo Japan"},{"name":"Department of Cardiovascular Medicine Graduate School of Medical Sciences, Kumamoto University  Kumamoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kensuke","family":"Takagi","sequence":"additional","affiliation":[{"name":"Department of Interventional Cardiology New Tokyo Hospital  Matsudo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroaki","family":"Obata","sequence":"additional","affiliation":[{"name":"Department of Interventional Cardiology New Tokyo Hospital  Matsudo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alaide","family":"Chieffo","sequence":"additional","affiliation":[{"name":"Department of Interventional Cardiology San Raffaele Scientific Institute  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Montorfano","sequence":"additional","affiliation":[{"name":"Department of Interventional Cardiology San Raffaele Scientific Institute  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunao","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Department of Interventional Cardiology New Tokyo Hospital  Matsudo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Colombo","sequence":"additional","affiliation":[{"name":"Department of Interventional Cardiology Maria Cecilia Hospital GVM  Cotignola Italy"},{"name":"Department of Interventional Cardiology EMO\u2010GVM Centro Cuore Columbus  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,12,29]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2013.11.014"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1610227"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.07.005"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.109.868091"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.664920"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.808402"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.116.003359"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1253\/circj.CJ-10-1182"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2008.03.075"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehn512"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2013.08.009"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0300-8932(09)71324-7"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10157-006-0453-4"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.685313"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2017.09.207"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.01.023"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.25178"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.09.1066"}],"container-title":["Catheterization 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