Differential Prognosis of True Bifurcation Lesions According to Left Main Versus Non-Left Main Location and Treatment
Ki Hong Choi1, Chang-Wook Nam2, Francesco Bruno3
1Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea.
Insights
True bifurcation lesions in the left main coronary artery (LM) carry a higher risk of major adverse cardiac events (MACEs) compared to non-LM bifurcations. A one-stent strategy is recommended for LM non-true bifurcations.
Area of Science:
- Interventional Cardiology
- Cardiovascular Research
- Clinical Outcomes
Background:
- True bifurcation lesions pose a high risk of procedural complications.
- Prognostic implications of percutaneous coronary intervention (PCI) for true bifurcations vary by lesion location.
- Optimal treatment strategies for bifurcation subtypes remain unclear.
Purpose of the Study:
- To compare clinical outcomes of true bifurcation lesions between left main coronary artery (LM) and non-LM bifurcations.
- To determine the optimal treatment strategy for different bifurcation lesion subtypes in the current drug-eluting stent era.
Main Methods:
- The ULTRA-BIFURCAT registry merged data from 6548 patients with bifurcation lesions.
- Patients were stratified by lesion location (LM vs. non-LM) and subtype (true vs. non-true bifurcation).
- The primary endpoint was major adverse cardiac events (MACEs) at 800 days.
Main Results:
- LM true bifurcations had significantly higher MACE risk (20.2%) than non-LM true bifurcations (9.0%).
- For LM true bifurcations, MACE rates were similar between 1-stent and 2-stent strategies.
- For LM non-true bifurcations, a 1-stent strategy showed lower MACE risk than a 2-stent strategy.
Conclusions:
- Clinical outcomes are worse for left main (LM) true bifurcation lesions compared to non-LM true bifurcation lesions.
- A provisional one-stent strategy is the preferred approach for treating LM non-true bifurcation lesions.
Background:
Although true bifurcation lesions are associated with a high risk of procedural complications, the differential prognostic implications of percutaneous coronary intervention for true bifurcations according to lesion location are unclear. This study aimed to identify whether clinical outcomes of true bifurcation lesions differed between left main coronary artery (LM) and non-LM bifurcations and to determine the optimal treatment strategy for subtypes of bifurcation lesions in the current-generation drug-eluting stent era.
Methods:
The ULTRA-BIFURCAT (Combined Insights From the Unified COBIS III, RAIN, and ULTRA Registries) was created by merging 3 bifurcation-dedicated registries from Korea and Italy. For this, 6548 patients treated with bifurcation lesions were stratified by lesion location and subtype. The primary end point was major adverse cardiac events (MACEs; composite of all-cause death, myocardial infarction, target lesion revascularization, and stent thrombosis) at 800 days.
Results:
In patients with an LM bifurcation, those with a true bifurcation had a significantly higher risk of a MACE than those with a nontrue bifurcation (20.2% versus 13.4%, adjusted hazard ratio [HR], 1.44 [95% CI, 1.11-1.86]; P=0.006). Conversely, there was no significant difference in the risk of a MACE according to true versus nontrue bifurcation in patients with non-LM bifurcation lesions (9.0% versus 8.8%; adjusted HR, 1.02 [95% CI, 0.82-1.27]; P=0.849). For LM true bifurcations, MACE rates were comparable between 1-stent and 2-stent strategies, whereas for LM nontrue bifurcations, the 2-stent strategy was associated with a significantly higher risk of MACEs than the 1-stent strategy. No significant differences in the risk of MACEs were observed in non-LM bifurcation lesions according to lesion subtype or treatment strategy.
Conclusions:
Clinical outcomes were worse for LM true bifurcation lesions than non-LM true bifurcation lesions. A provisional 1-stent strategy should be the preferred approach for treating LM nontrue bifurcation lesions.
Registration:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT03068494, NCT03544294, and NCT05205148.
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