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Percutaneous coronary intervention involving coronary bifurcation is associated with higher mortality and
Allistair Nathan1, Mehrtash Hashemzadeh1, Mohammad Reza Movahed1,2
1University of Arizona Phoenix, AZ, USA.
Insights
Percutaneous coronary intervention (PCI) for bifurcation lesions leads to higher inpatient mortality and complications compared to non-bifurcation lesions. This study highlights increased risks for patients undergoing PCI for complex bifurcation lesions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Outcomes Research
Background:
- Percutaneous coronary intervention (PCI) in patients with bifurcation lesions presents increased complexity and adverse outcomes.
- Evaluating inpatient outcomes for PCI in bifurcation lesions is crucial for understanding patient risk.
Purpose of the Study:
- To assess and compare inpatient mortality and complication rates between PCI for bifurcation lesions and non-bifurcation lesions.
- To identify specific adverse outcomes associated with PCI in bifurcation lesions.
Main Methods:
- Utilized the National Inpatient Sample (NIS) database from 2016-2020, analyzing ICD-10 codes.
- Compared patients undergoing PCI for bifurcation lesions versus non-bifurcation lesions, excluding chronic total occlusions.
- Evaluated post-procedural inpatient mortality and complication rates.
Main Results:
- PCI for bifurcation lesions was linked to significantly higher mortality (3.79% vs. 2.56%) and post-procedural complications.
- Multivariate analysis confirmed higher mortality (OR, 1.68) for bifurcation PCI, adjusting for comorbidities.
- Increased rates of myocardial infarction, coronary perforation, tamponade, and procedural bleeding were observed in the bifurcation group.
Conclusions:
- PCI for bifurcation lesions is associated with significantly elevated inpatient mortality and complication rates.
- These findings underscore the higher risk profile of PCI procedures involving bifurcation lesions.
- The study emphasizes the need for careful consideration of risks in complex coronary interventions.
Background:
Percutaneous coronary intervention (PCI) in patients with bifurcation lesions is associated with higher complexity and adverse outcomes. The goal of this study was to evaluate the inpatient outcomes of patients with PCI of bifurcation lesions.
Methods:
The National Inpatient Sample (NIS) database, years 2016-2020, was studied using ICD 10 codes. Patients undergoing PCI for bifurcation lesions were compared to those undergoing PCI for non-bifurcation lesions, excluding chronic total occlusion lesions. We evaluated post-procedural inpatient mortality and complications.
Results:
PCI in patients with bifurcation lesions was associated with higher mortality and post-procedural complications. A weighted total of 9,795,154 patients underwent PCI; of those, 43,480 had a bifurcation lesion. The bifurcation cohort had a 3.79% mortality rate, and the rate in those with non-bifurcation lesions was 2.56% (OR, 1.50; CI: 1.34-1.68; P<0.001). Upon conducting multivariate analysis, which adjusted for age, sex, race, and significant comorbidities, PCI for bifurcation lesions remained significantly associated with a higher mortality rate compared to non-bifurcation lesion PCI (OR, 1.68; 95% CI, 1.49-1.88; P<0.001). Furthermore, PCI for bifurcation lesions was associated with higher rates of myocardial infarction (OR, 2.26; 95% CI, 1.68-3.06; P<0.001), coronary perforation (OR, 7.97; 95% CI, 6.25-10.17; P<0.001), tamponade (OR, 3.46; 95% CI, 2.49-4.82; P<0.001), and procedural bleeding (OR, 5.71; 95% CI, 4.85-6.71; P<0.001). Overall, post-procedural complications were 4 times more in patients with bifurcation lesions than in those without (OR, 4.33; 95% CI, 3.83-4.88; P<0.001).
Conclusion:
Using a large, national inpatient database, we demonstrate that both mortality rates and post-procedural complication rates were significantly higher in patients undergoing PCI for bifurcation lesions than in those undergoing PCI for non-bifurcation lesions.
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