Clinical and Angiographic Profile of Patients Undergoing Coronary Bifurcation Percutaneous Coronary Intervention and Short-Term Outcomes

Authors

  • Akash Karwa Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Civil Hospital Campus, Asarwa, Ahmedabad- 380016, Gujarat, India.
  • Jayal Shah Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Civil Hospital Campus, Asarwa, Ahmedabad- 380016, Gujarat, India.
  • Gourav Behra Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Civil Hospital Campus, Asarwa, Ahmedabad- 380016, Gujarat, India.
  • Riyaz Charaniya Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Civil Hospital Campus, Asarwa, Ahmedabad 380016, Gujarat, India.
  • Krutika Patel Department of Research, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Civil Hospital Campus, Asarwa, Ahmedabad-380016, Gujarat, India.
  • Kishan Hibare Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Civil Hospital Campus, Asarwa, Ahmedabad-380016, Gujarat, India.
  • Sagar Vejani Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Civil Hospital Campus, Asarwa, Ahmedabad-380016, Gujarat, India.
  • Megh Shah Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Civil Hospital Campus, Asarwa, Ahmedabad-380016, Gujarat, India.

DOI:

https://doi.org/10.18502/rhythm.v21i4.23089

Keywords:

Bifurcation; Complex Coronary Intervention; Follow-up; Percutaneous Coronary Intervention; India

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.

Published

2026-10-28

Issue

Volume (21) issue (4)

Section

Articles