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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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Percutaneous coronary intervention of bifurcation lesions and platelet reactivity

Björn Redfors1, Philippe Généreux2, Bernhard Witzenbichler3

  • 1Cardiovascular Research Foundation, New York, NY, United States.

International Journal of Cardiology
|October 28, 2017
PubMed

Insights

Successful bifurcation percutaneous coronary intervention (PCI) still carries a higher risk of adverse events. Stenting both branches significantly increases this risk, independent of residual platelet reactivity.

Area of Science:

  • Interventional Cardiology
  • Cardiovascular Research
  • Biomedical Engineering

Background:

  • Bifurcation percutaneous coronary intervention (PCI) presents unique challenges, often linked to lower success rates and increased complications.
  • Limited data exist on outcomes following successful bifurcation PCI using modern stents and techniques.
  • The impact of residual platelet reactivity (PR) on outcomes after bifurcation versus non-bifurcation PCI remains unclear.

Purpose of the Study:

  • To evaluate the clinical outcomes of patients undergoing successful bifurcation PCI compared to non-bifurcation PCI.
  • To investigate the association between bifurcation PCI, residual platelet reactivity (PR), and adverse cardiovascular events.
  • To assess the impact of stenting both bifurcation branches on patient outcomes.

Main Methods:

  • Analysis of data from the prospective, multicenter ADAPT-DES study.
  • Stratification of 8582 patients into bifurcation PCI and non-bifurcation PCI groups.
  • Comparison of two-year outcomes using Cox proportional hazards models, defining target vessel failure (TVF) as a composite endpoint.

Main Results:

  • Bifurcation PCI (15% of patients) was independently associated with a higher risk of TVF (aHR 1.26, p=0.003), driven by increased myocardial infarction and ischemia-driven target vessel revascularization.
  • No significant interaction was found between PR and bifurcation PCI for TVF risk (pinteraction=0.87).
  • Stenting both bifurcation branches significantly elevated TVF risk (aHR 1.91 vs. non-bifurcation PCI, ptrend<0.001).

Conclusions:

  • Bifurcation PCI is linked to an increased risk of adverse ischemic events at two years compared to non-bifurcation PCI.
  • The risk is substantially higher when both branches of a bifurcation are stented.
  • High residual platelet reactivity (HPR) poses a similar risk for both bifurcation and non-bifurcation PCI patients.
Abstract

Keywords:
Bifurcation lesionsDrug-eluting stentsPercutaneous coronary interventionPlatelet reactivityTarget vessel failure

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