Characteristics and Outcomes of Patients Undergoing Complex Bifurcation versus Non-bifurcation Percutaneous Coronary Intervention.
Presenter
Ilias Nikolakopoulos, M.D., Minneapolis Heart Institute® - Abbott Northwestern Hospital, Minneapolis, MN
Ilias Nikolakopoulos, M.D.1, Evangelia Vemmou, MD1, Judit Karacsonyi, MD, PhD1, Ross Garberich, MS, MBA2, Larissa Stanberry, PhD3, Denise L. Mueller, MA4, Bavana V Rangan, BDS, MPH2, M. Nicholas Burke, M.D.1 and Emmanouil S. Brilakis, MD, PhD, FSCAI1, (1)Minneapolis Heart Institute® - Abbott Northwestern Hospital, Minneapolis, MN, (2)Minneapolis Heart Institute Foundation, Minneapolis, MN, (3)Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN, (4)Allina Health, Minneapolis, MN
Keywords: Chronic Total Occlusion (CTO), Complex and High-risk Coronary Intervention (CHIP), Coronary, Hemodynamic support and Left Main and Bifurcations
Background
The outcomes of complex bifurcation versus non-bifurcation percutaneous coronary interventions (PCI) have received limited study.
Methods
We analyzed data from Minneapolis Heart Institute included in the National Cardiovascular Data Registry (NCDR) Cath PCI Registry between 2014-2019. Complexity was defined as per NCDR. Technical success was defined as guidewire advancement across the lesion with final TIMI 3 flow and residual stenosis <30% (for lesions involving multiple segments, the highest post-procedure stenosis and lowest TIMI flow were reported).
Results
Bifurcation PCI is less likely to be performed for an acute coronary syndrome (62% vs 69%,
P<.0001
) but more likely to be performed concomitantly with other PCI and to involve use of mechanical ventricular support (5% vs 1.2%,
P<.0001). Technical success (94% vs 94.2%,
P=0.85) and major adverse cardiovascular event (MACE) rates (2.5% vs 1.9%,
P=0.21) were similar. Coronary dissection was higher for bifurcation PCI (3.9% vs 1.3%,
P<.0001). In multivariable analysis (
Figure), bifurcation PCI was associated with lower technical success rates and higher dissection rates, but not with higher MACE rates.
Conclusions
Compared with complex non-bifurcation PCIs, complex bifurcation PCIs are associated with higher rates of dissection.
