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Updated: Jun 15, 2026
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Long-term prognosis after coronary bifurcation PCI-A nationwide observational study
András Katona1,2, Sacharias von Koch3, Pontus Andell4
1Faculty of Health, Department of Cardiology, Örebro University, Örebro, Sweden.
Insights
Complex percutaneous coronary intervention (PCI) for left anterior descending artery (LAD) and D1 bifurcation lesions showed better long-term outcomes than simple PCI. This approach reduced major adverse clinical events, primarily driven by lower all-cause mortality over five years.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Long-term outcomes of percutaneous coronary intervention (PCI) for bifurcation lesions remain under-explored.
- Specific focus on proximal LAD bifurcation lesions involving D1 is needed.
Purpose of the Study:
- To investigate and compare the long-term outcomes of simple versus complex PCI for proximal LAD-D1 bifurcation lesions.
Main Methods:
- A Swedish registry-based study included 6,796 patients undergoing LAD-D1 bifurcation PCI with drug-eluting stents (2010-2020).
- Patients were categorized into simple PCI (proximal LAD stent only) and complex PCI (kissing balloon or 2-stent approach for LAD and D1).
- Major adverse clinical events (MACE), defined as all-cause death or myocardial infarction, were analyzed using multivariable Cox regression.
Main Results:
- Complex PCI (n=2,007) demonstrated lower 1-year MACE rates (6.2% vs. 7.9%) compared to simple PCI (n=4,789), primarily due to reduced all-cause mortality (3.6% vs. 5.0%).
- These outcome differences persisted over five years.
- No significant differences were found in myocardial infarction, target revascularization, CABG, stent thrombosis, stroke, or bleeding between the groups.
Conclusions:
- Complex PCI for LAD/D1 bifurcation lesions is associated with improved long-term outcomes compared to simple PCI in a real-world clinical setting.
- The findings suggest that complex PCI strategies may be beneficial for managing these specific coronary artery lesions.
Background:
Long-term outcomes of percutaneous coronary intervention (PCI) for bifurcation lesions are underexplored. We investigated long-term PCI outcomes for proximal LAD bifurcation lesions involving D1.
Methods:
Using Swedish registries, we included all patients undergoing LAD-D1 bifurcation PCI with drug-eluting stents between 2010 and 2020. Patients were stratified into two groups: simple PCI and complex PCI. The simple PCI group included those with stents in the proximal LAD only, while complex PCI involved the kissing balloon technique or a 2-stent approach for the proximal LAD and D1. A multivariable Cox regression model was used to estimate event rates of major adverse clinical events (MACE), defined as all-cause death or a new myocardial infarction. Secondary outcomes included target segment revascularization or coronary artery by-pass graft surgery (CABG) and definite stent thrombosis.
Results:
A total of 6,796 individuals were analyzed: 2,007 underwent complex PCI and 4,789 simple PCI. Baseline characteristics were comparable between groups. The complex PCI group was slightly younger, more often male, and more frequently taking statins. At 1-year, MACE rates were lower in the complex PCI group (6.2% vs 7.9%; adjusted HR 0.74, 95% CI 0.59-0.93, p = 0.010). The result was driven by lower all-cause mortality (3.6% vs. 5.0%; adjusted HR 0.73, 95% CI 0.54-0.98, p = 0.036). No significant differences in myocardial infarction, target segment revascularization, CABG, stent thrombosis, stroke, or bleeding were observed between groups, persisting at five years.
Conclusion:
Over a five-year period, complex PCI of LAD/D1 bifurcation lesions was associated with better outcome than simple PCI in a routine clinical setting.
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