Kardiologia polska · 2026
Very-long-term clinical outcomes following percutaneous coronary interventions for culprit lesions involving coronary bifurcations in patients with non-ST-segment elevation acute coronary syndromes: A propensity score matching analysis.
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Liszka Radosław, Bujak Kamil, Skrzypek Michał, Pyka Łukasz, Gąsior Mariusz
Аннотация
BACKGROUND: Coronary bifurcation lesions are associated with a higher rate of reintervention thannon-bifurcation lesions, particularly in acute coronary syndromes (ACS). However, data on theprognostic implications of bifurcation lesions at very long follow-up are scarce.
AIMS: We therefore aimed to compare 10-year clinical outcomes after percutaneous coronary intervention for bifurcation versus non-bifurcation culprit lesions in a large cohort of patients withnon-ST-segment elevation ACS (NSTE-ACS).
METHODS: This retrospective study included patients with NSTE-ACS who underwent percutaneouscoronary intervention at a single referral center between 2008 and 2018. Patients were stratifiedby culprit lesion location (bifurcation vs. non-bifurcation). The primary endpoint was 10-year majoradverse cardiac and cerebrovascular events (MACCE), a composite of all-cause death, myocardialinfarction, and stroke. Propensity score matching was used to adjust for differences in baselinecharacteristics between groups.
RESULTS: A total of 1694 patients were included: 456 presented with bifurcation and 1238 withnon-bifurcation culprit lesions. In the unmatched population, patients with bifurcation lesions wereolder, had higher GRACE scores, and more often presented with multivessel disease than thosewith non-bifurcation lesions. There was a higher risk of MACCE (hazard ratio, 1.30; 95% confidenceinterval, 1.13-1.50) in the bifurcation-lesion group, driven primarily by myocardial infarction. Afterpropensity score matching, there were 346 patient pairs, and the risk of MACCE (hazard ratio, 1.07; 95% confidence interval, 0.88-1.30) and its components was similar between the groups.
CONCLUSIONS: In patients with NSTE-ACS, lesions located within bifurcations did not appear to affect MACCE or its components at 10 years, compared with non-bifurcation culprit lesions.
AIMS: We therefore aimed to compare 10-year clinical outcomes after percutaneous coronary intervention for bifurcation versus non-bifurcation culprit lesions in a large cohort of patients withnon-ST-segment elevation ACS (NSTE-ACS).
METHODS: This retrospective study included patients with NSTE-ACS who underwent percutaneouscoronary intervention at a single referral center between 2008 and 2018. Patients were stratifiedby culprit lesion location (bifurcation vs. non-bifurcation). The primary endpoint was 10-year majoradverse cardiac and cerebrovascular events (MACCE), a composite of all-cause death, myocardialinfarction, and stroke. Propensity score matching was used to adjust for differences in baselinecharacteristics between groups.
RESULTS: A total of 1694 patients were included: 456 presented with bifurcation and 1238 withnon-bifurcation culprit lesions. In the unmatched population, patients with bifurcation lesions wereolder, had higher GRACE scores, and more often presented with multivessel disease than thosewith non-bifurcation lesions. There was a higher risk of MACCE (hazard ratio, 1.30; 95% confidenceinterval, 1.13-1.50) in the bifurcation-lesion group, driven primarily by myocardial infarction. Afterpropensity score matching, there were 346 patient pairs, and the risk of MACCE (hazard ratio, 1.07; 95% confidence interval, 0.88-1.30) and its components was similar between the groups.
CONCLUSIONS: In patients with NSTE-ACS, lesions located within bifurcations did not appear to affect MACCE or its components at 10 years, compared with non-bifurcation culprit lesions.