Clinical and Angiographic Profile of Patients Undergoing Coronary Bifurcation Percutaneous Coronary Intervention and Short-Term Outcomes
TL;DR
The findings emphasize the importance of addressing myocardial dysfunction in risk stratification and management to improve outcomes in this high-risk population and highlight the importance of addressing myocardial dysfunction in risk stratification and management in this high-risk population.
Abstract
Background: Coronary bifurcation lesions pose substantial challenges in percutaneous coronary intervention (PCI). This study aimed to assess the clinical and angiographic characteristics of patients undergoing PCI for bifurcation lesions in a South Asian population and to evaluate short-term outcomes. Methods: This prospective observational study was performed from June 2022 through September 2023 at a tertiary cardiac care center in individuals undergoing PCI for coronary bifurcation lesions. Results: A total of 259 participants were enrolled, with a mean (SD) age of 57.4 (10.9) years; 78.8% were male.The Medina classification indicated that the most common bifurcation lesion was left main–left anterior descending (LM–LAD) (43.2%). A total of 206 participants had LM bifurcation lesions, whereas 53 had non-LM lesions, with the LAD being the most frequently involved culprit vessel (94.2%). Ostial lesions were present in 68.3% of cases, and calcification was significantly more common in LM lesions (14.6%) than in non-LM lesions (1.9%; P=.01). Provisional stenting was the most common technique (62.6%), with double kiss crush used more frequently in LM bifurcation lesions (20.4% vs 3.8%; P < .001). Major adverse cardiovascular events (MACE) occurred in 38 participants (14.7%); they included 18 cardiac deaths (6.9%) and 13 cases of target vessel failure (TVF) (5.0%). No significant differences in MACE (P=.23) or death (P=.10) were observed between bifurcation lesion types or stenting strategies. Intravascular ultrasonography (IVUS) guidance was utlized in 70.3% of participants and was potentially associated with improved outcomes. Kaplan–Meier analysis revealed that severe left ventricular dysfunction was associated with a nearly 3-fold greater risk of death (hazard ratio [HR], 2.96; 95% CI, 0.98 to 8.96) and was the only independent predictor of all-cause mortality (HR, 3.23; 95% CI, 1.14 to 9.14; P=.027). Conclusion: Procedural complexity and lesion-related factors were not significantly associated with short-term mortality. These findings emphasize the importance of addressing myocardial dysfunction in risk stratification and management to improve outcomes in this high-risk population.