Decoding medina 0.0.1 bifurcation: Are all codes equal? Results from a multicentric registry

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Biology

Background:

• Medina 0.0.1 bifurcations represent a rare and understudied subset of coronary artery disease.
• Optimal treatment strategies for these lesions remain debated and lack comprehensive description in clinical practice.

Purpose of the Study:

• To elucidate the technical management of Medina 0.0.1 lesions.
• To evaluate the clinical outcomes associated with these lesions.
• To identify predictors of Major Adverse Cardiovascular Events (MACE).

Main Methods:

• A multicenter international registry included 273 patients with 277 de novo Medina 0.0.1 lesions treated with percutaneous coronary intervention (PCI) between 2017 and 2022.
• Systematic data collection and clinical follow-up were performed, with a primary endpoint of 3-year MACE.
• Secondary endpoints included Target Lesion Revascularization (TLR) and stent thrombosis.

Main Results:

• The median follow-up was 1180 days. Most lesions (84.1%) were treated with a single stent, primarily using inverted provisional (53.6%) or ostial stenting (45.9%).
• The 3-year incidence of MACE was 16.9%, and TLR was 13.4%.
• Diabetes was identified as the only independent predictor of 3-year MACE (adjusted HR 2.35, p=0.01). Proximal optimization technique use was associated with significantly reduced MACE (HR 0.28, p=0.03).

Conclusions:

• Medina 0.0.1 bifurcations are associated with substantial long-term MACE and TLR rates.
• Diabetes mellitus is the primary independent risk factor for adverse outcomes in this patient cohort.
• Adherence to current guidelines for bifurcation angioplasty is inconsistent, particularly for smaller bifurcations and in acute settings.