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Two-Year Clinical Outcomes in Patients With Coronary Bifurcation Lesions: Results From the Onyx ONE Clear Study

Christopher Garnett1, David E Kandzari2, Azeem Latib3

  • 1Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York.

Journal of the Society for Cardiovascular Angiography & Interventions
|July 28, 2026
PubMed

Insights

High bleeding risk patients with bifurcation lesions can safely undergo abbreviated dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI). This study found similar ischemic and bleeding events compared to those without bifurcation lesions.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • Optimal dual antiplatelet therapy (DAPT) duration for high bleeding risk (HBR) patients post-percutaneous coronary intervention (PCI) is debated.
  • Bifurcation lesions increase ischemic event risk, raising questions about abbreviated DAPT safety in HBR patients with these lesions.

Purpose of the Study:

  • To evaluate ischemic and bleeding outcomes in HBR patients with and without bifurcation lesions undergoing PCI.
  • To determine if abbreviated DAPT (1 month) is safe for HBR patients with bifurcation lesions.

Main Methods:

  • Analysis of data from the Onyx ONE Clear study, including HBR patients treated with Resolute Onyx zotarolimus-eluting stents.
  • Comparison of outcomes between HBR patients with and without bifurcation lesions, all receiving 1 month of DAPT post-event-free 1 month.

Main Results:

  • 14.3% of 1507 HBR patients had bifurcation lesions, mostly treated with a provisional approach.
  • No significant differences in composite cardiac death/myocardial infarction rates (12.2% vs 11.6%) between bifurcation and non-bifurcation lesion groups.
  • Similar rates of BARC 3-5 bleeding events and other clinical/angiographic outcomes across both groups.

Conclusions:

  • HBR patients with bifurcation lesions treated with Resolute Onyx stents and 1-month DAPT experienced comparable ischemic event rates to those without bifurcation lesions.
  • Abbreviated DAPT appears safe in HBR patients with bifurcation lesions, even with increased lesion and procedural complexity.
Abstract

Keywords:
bifurcationcoronary artery diseasedrug-eluting stentshort-term dual antiplatelet therapyzotarolimus-eluting stent

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