To Örebro University

Background: Coronary bifurcation stenting is a debated topic in percutaneous coronary intervention (PCI). We explored the outcomes of PCI in proximal left anterior descending (LAD) coronary bifurcation lesions involving the first diagonal branch (D1).

Methods: The Swedish Coronary Angiography and Angioplasty Registry (SCAAR) was used to include all patients undergoing LAD-D1 bifurcation PCI from 2010 to 2020 in Sweden. Two groups were defined: simple PCI and complex PCI. The simple PCI group comprised patients with stent implantation involving only the proximal LAD, and complex PCI was defined as kissing balloon technique or a 2-stent approach of proximal LAD and D1. A multivariable Cox regression model was used to assess major adverse clinical events (MACE) after 1 year, defined as all-cause mortality or myocardial infarction (MI).

Results: A total of 2,007 patients underwent complex PCI and 4,789 simple PCI. The complex PCI group was slightly younger, more often male, and more often 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). The result was driven by lower rates of all-cause mortality (3.6% vs 5.0%; adjusted HR: 0.73; 95% CI: 0.54-0.98). No difference was observed in MI, target segment revascularization or coronary artery bypass graft surgery, definite stent thrombosis, bleeding and stroke.

Conclusions: Over a 5-year period, complex PCI of LAD/D1 bifurcation lesions was associated with better outcome than simple PCI in a routine clinical setting.

Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP).