Impact of Medina classification on clinical outcomes of imaging-guided coronary bifurcation stenting
Yoshinobu Murasato1, Yoshihisa Kinoshita2, Masahiro Yamawaki3
1Department of Cardiology & Clinical Research Centre, National Hospital Organization, Kyusyu Medical Centre, Fukuoka, Japan.
Insights
Intracoronary imaging guides complex coronary bifurcation lesion stenting. While outcomes are similar for most lesion types, 0-0-1 Medina classification lesions show significantly higher risks of major adverse cardiac events and target lesion revascularization.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Intracoronary imaging enhances outcomes in complex coronary bifurcation lesions (CBLs).
- The impact of Medina classification on imaging-guided stenting outcomes remains unclear.
Purpose of the Study:
- To analyze the distribution of CBLs using Medina classification.
- To evaluate the impact of CBL distribution on outcomes after imaging-guided stenting.
Main Methods:
- Integrated analysis of four studies involving 763 CBLs treated with drug-eluting stents.
- Intravascular ultrasound or optical coherence tomography guidance was used.
- Medina classification assessed lesion distribution; major adverse cardiac events (MACE) and target lesion revascularization (TLR) were tracked at 1-year.
Main Results:
- The 0-1-0 Medina subtype was most prevalent (27.9%), and 0-0-1 was least (2.8%).
- 0-0-1 lesions had the highest MACE/TLR rates (18.2%), while 0-1-0 had the lowest (4.1%/2.8%).
- 0-0-1 lesions showed significantly higher MACE (HR: 4.04) and TLR (HR: 6.19) risks compared to 0-1-0 lesions.
Conclusions:
- Imaging-guided stenting of CBLs yields similar outcomes for most lesion types.
- 0-0-1 Medina classification lesions represent a high-risk subgroup with increased MACE/TLR.
- Risk stratification based on Medina classification is crucial for optimizing CBL stenting outcomes.
Background:
Intracoronary imaging improves clinical outcomes after stenting of complex coronary bifurcation lesions (CBLs), but the impact of Medina classification-based CBL distribution on outcomes of imaging-guided bifurcation stenting is unclear.
Methods:
In this integrated analysis of four previous studies, in which all CBLs were treated with drug-eluting stents under intravascular ultrasound or optical coherence tomography guidance, the distribution of 763 CBLs was assessed using angiographic Medina classification. Major adverse cardiac events (MACE), including target lesion revascularization (TLR), myocardial infarction, stent thrombosis, and cardiac death, were investigated at 1-year follow-up.
Results:
The most and least prevalent Medina subtypes were 0-1-0 (27.9 %) and 0-0-1 lesions (2.8 %). The most and least frequent MACE/TLR rates were 18.2 %/18.2 % for 0-0-1 lesions and 4.1 %/2.8 % for 0-1-0 lesions. Risks were higher for 0-0-1 lesions than for 0-1-0 lesions for both MACE (hazard ratio [HR]: 4.04, 95 % confidence interval [CI]: 1.21-13.45, p = 0.02) and TLR (HR: 6.19, 95 % CI: 1.69-22.74, p = 0.006). MACE rates were similar for true and non-true CBLs excluding 0-0-1 lesions (8.2 % and 5.9 %, HR 1.54, 95 % CI: 0.86-2.77, p = 0.15), while MACE (HR: 3.25, 95 % CI: 1.10-9.63, p = 0.03) and TLR (HR: 4.24, 95 % CI: 1.38-12.96, p = 0.01) risks were higher for 0-0-1 lesions.
Conclusions:
This integrated analysis of imaging-guided bifurcation stenting demonstrated similar clinical outcomes in true and non-true CBLs, except for 0-0-1 lesions, which had a significantly higher risk of MACE/TLR.
