Mid-term outcomes after percutaneous interventions in coronary bifurcations

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Medicine

Background:

• Optimal treatment strategies for percutaneous coronary interventions (PCI) in coronary bifurcations remain a subject of ongoing debate.
• Coronary bifurcations represent complex anatomies requiring specialized approaches during PCI.

Purpose of the Study:

• To identify independent predictors of mid-term Major Adverse Cardiac Events (MACE) following PCI in patients with coronary bifurcation lesions.
• To evaluate the impact of various clinical, procedural, and treatment-related factors on patient outcomes after complex PCI.

Main Methods:

• A retrospective analysis of 5036 consecutive patients undergoing PCI for coronary bifurcations across 17 centers (2012-2014).
• Multivariable Cox regression and sensitivity analyses were employed to identify independent predictors of MACE.
• Follow-up data for 4506 patients (89%) were analyzed at a median of 18 months.

Main Results:

• Major Adverse Cardiac Events (MACE) occurred in 8.8% of patients, including cardiac death (3.4%), myocardial infarction (3.5%), and stent thrombosis (2.4%).
• Independent predictors of MACE included left ventricular ejection fraction ≤30%, bail-out stenting, acute coronary syndrome admission, age >66 years, multivessel disease, and diabetes.
• Premature discontinuation of dual antiplatelet therapy (DAPT) and side branch (SB) lesion length ≥9 mm were identified as additional independent predictors of MACE.

Conclusions:

• Multivessel disease, SB lesion length, bail-out stenting, and premature DAPT discontinuation are significant predictors of mid-term MACE after coronary bifurcation PCI.
• A meticulously planned PCI strategy and strict adherence to DAPT are crucial for improving clinical outcomes in patients undergoing complex bifurcation interventions.