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Updated: Dec 18, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Cardiovascular outcomes after percutaneous coronary intervention on bifurcation lesions with moderate to severe
Jonathan Luke Murphy1, Nileshkumar Patel1, Yuliya Vengrenyuk1
1Cardiovascular Institute, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Insights
Complex coronary artery disease patients with both bifurcations and moderate/severe calcification face higher risks after percutaneous coronary intervention (PCI). This combination significantly increases major adverse cardiac events (MACE) risk compared to individual factors.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Percutaneous coronary intervention (PCI) outcomes are negatively impacted by target vessel calcification and bifurcation lesions.
- The combined effect of these factors on PCI outcomes in complex coronary artery disease remains unclear.
Purpose of the Study:
- To investigate the association of target vessel bifurcation and calcification, individually and combined, with adverse events post-PCI.
- To assess the impact of these combined factors on major adverse cardiac events (MACE).
Main Methods:
- Analysis of registry data from 21,165 patients undergoing PCI with drug-eluting stents (DES).
- Patients categorized into four groups based on bifurcation presence and calcification severity (none/mild vs. moderate/severe).
- Cox regression analysis used to evaluate 1-year MACE rates across groups.
Main Results:
- The highest unadjusted rates of MACE, death, myocardial infarction (MI), and stent thrombosis occurred in patients with both bifurcation lesions and moderate/severe calcification.
- Adjusted hazard ratios for MACE were significantly higher for patients with bifurcation and none/mild calcification (1.14), no bifurcation and moderate/severe calcification (1.21), and particularly for bifurcation with moderate/severe calcification (1.37) compared to the reference group.
Conclusions:
- A bifurcating target vessel with moderate/severe calcification independently increases the risk of adverse outcomes post-PCI.
- Novel strategies are required to mitigate risks and improve PCI outcomes in this high-risk patient subgroup with complex coronary artery disease.
Background:
Both target vessel calcification and target vessel bifurcation are associated with worse outcomes following percutaneous coronary intervention (PCI). Whether these entities in combination interact to influence outcomes after PCI of complex coronary disease is not known.
Objectives:
This study evaluated the association of target vessel bifurcation and target vessel calcification, alone and in combination, with adverse events following PCI.
Methods:
Registry data from 21,165 patients who underwent PCI with drug-eluting stents (DES) between January 2009 and December 2017 were analyzed. Patients were divided into four groups according to the presence or absence of target vessel bifurcation and presence of none/mild or moderate/severe target vessel calcification on angiography. Associations between lesion groups and 1 year major adverse cardiac events (MACE) were examined using Cox regression analysis.
Results:
At 1 year, unadjusted rates of MACE, death, myocardial infarction (MI), as well as stent thrombosis were highest in the group with both bifurcation lesion and moderate/severe calcification. After adjusting for confounders such as age, renal disease, and smoking, hazard ratios for MACE were 1.14 (95%CI 0.99-1.33) for bifurcation with none/mild calcification, 1.21 (95%CI 1.06-1.38) for no bifurcation and moderate/severe calcification, and 1.37 (95%CI 1.14-1.64) for bifurcation and moderate severe calcification, compared to patients with no bifurcation and none/mild calcification.
Conclusions:
The presence of a bifurcating target vessel with moderate/severe calcification is associated with a higher risk of adverse outcomes than either attribute alone. New approaches are needed to improve outcomes in this subset of patients with complex coronary artery disease.
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