Optimal stent deployment in left main (LM) bifurcation is paramount, and incomplete stent apposition may cause major adverse cardiac events (MACE). Bench studies show that the proximal optimization technique (POT) provides the best stent apposition.

We aimed to investigate the impact of POT on clinical outcomes in patients treated for unprotected LM (ULM) disease at our institution.

We identified 162 patients who underwent percutaneous coronary intervention (PCI) for ULM coronary disease in the Cardio‐FR database. Out of these, 99 (61%) had undergone POT, while 63 patients were treated without POT. The primary outcome was the bifurcation‐oriented composite endpoint (BOCE) of cardiac death, target‐bifurcation myocardial infarction and target‐bifurcation revascularization at maximal follow‐up.

Mean age was 76 years, and 69% presented with acute coronary syndrome. Mean follow‐up was 2.25 years (822 days). The BOCE occurred in 43 (27%) of which 20 (20%) in the POT group and 23 (37%) in the no‐POT group (p = 0.009). Cardiac death occurred in 15 (15%) patients in the POT‐ and 17 (27%) in no‐POT group (p = 0.26). Target bifurcation revascularization occurred in 4 (4%) patients in the POT‐ and 6 (10%) patients in the no‐POT group (p = 0.19). POT In the multivariate analysis, POT was the strongest parameter and was associated with BOCE, cardiac death, occurrence of any revascularization and all‐cause mortality.

The POT improves clinical outcomes. These findings strongly support the systematic use of POT in patients undergoing ULM‐PCI.