Long-term prognosis after coronary bifurcation PCI-A nationwide observational study

Abstract

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. Copyright: © 2025 Katona et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited