The 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

BACKGROUND: Coronary bifurcation lesions are associated with a higher rate of reintervention than non-bifurcation lesions, particularly in acute coronary syndromes (ACS). However, data on the prognostic 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 with non-ST-segment elevation ACS (NSTE-ACS). METHODS: This retrospective study included patients with NSTE-ACS who underwent percutaneous coronary intervention at a single referral center between 2008 and 2018. Patients were stratified by culprit lesion location (bifurcation vs. non-bifurcation). The primary endpoint was 10-year major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause death, myocardial infarction, and stroke. Propensity score matching was used to adjust for baseline characteristics differences between groups. RESULTS: A total of 1694 patients were included: 456 presented with bifurcation and 1238 with non-bifurcation culprit lesions. In the unmatched population, patients with bifurcation lesions were older, had higher GRACE scores, and more often presented with multivessel disease than those with non-bifurcation lesions. There was a higher risk of MACCE (hazard ratio, 1.30; 95% confidence interval, 1.13-1.50) in the bifurcation-lesion group, driven primarily by myocardial infarction. After propensity 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.