Key result
Percutaneous coronary intervention for bifurcation lesions was associated with significantly higher inpatient mortality compared to non-bifurcation lesions (adjusted OR 1.68).
Why the study?
PCI in patients with bifurcation lesions involves higher complexity and adverse outcomes, motivating an evaluation of inpatient outcomes following bifurcation PCI.
Does PCI for bifurcation lesions increase inpatient mortality and complications compared to non-bifurcation PCI?
Observational (n=9,795,154)
Yes
Does PCI for bifurcation lesions increase inpatient mortality and complications compared to non-bifurcation PCI?
Odds Ratio: 1.68 (95% CI 1.49–1.88)
Absolute Event Rate: 3.79% vs 2.56%
p-value: p=<0.001
PCI for bifurcation lesions is associated with significantly higher inpatient mortality and procedural complications compared to non-bifurcation PCI.
Bifurcation PCI linked to higher inpatient complications; leaves open whether specialized techniques improve real-world outcomes.
BACKGROUND: Percutaneous coronary intervention (PCI) in patients with bifurcation lesions is associated with higher complexity and adverse outcomes. The goal of this study was to evaluate the inpatient outcomes of patients with PCI of bifurcation lesions. METHODS: The National Inpatient Sample (NIS) database, years 2016-2020, was studied using ICD 10 codes. Patients undergoing PCI for bifurcation lesions were compared to those undergoing PCI for non-bifurcation lesions, excluding chronic total occlusion lesions. We evaluated post-procedural inpatient mortality and complications. RESULTS: PCI in patients with bifurcation lesions was associated with higher mortality and post-procedural complications. A weighted total of 9,795,154 patients underwent PCI; of those, 43,480 had a bifurcation lesion. The bifurcation cohort had a 3.79% mortality rate, and the rate in those with non-bifurcation lesions was 2.56% (OR, 1.50; CI: 1.34-1.68; P<0.001). Upon conducting multivariate analysis, which adjusted for age, sex, race, and significant comorbidities, PCI for bifurcation lesions remained significantly associated with a higher mortality rate compared to non-bifurcation lesion PCI (OR, 1.68; 95% CI, 1.49-1.88; P<0.001). Furthermore, PCI for bifurcation lesions was associated with higher rates of myocardial infarction (OR, 2.26; 95% CI, 1.68-3.06; P<0.001), coronary perforation (OR, 7.97; 95% CI, 6.25-10.17; P<0.001), tamponade (OR, 3.46; 95% CI, 2.49-4.82; P<0.001), and procedural bleeding (OR, 5.71; 95% CI, 4.85-6.71; P<0.001). Overall, post-procedural complications were 4 times more in patients with bifurcation lesions than in those without (OR, 4.33; 95% CI, 3.83-4.88; P<0.001). CONCLUSION: Using a large, national inpatient database, we demonstrate that both mortality rates and post-procedural complication rates were significantly higher in patients undergoing PCI for bifurcation lesions than in those undergoing PCI for non-bifurcation lesions.
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Allistair Nathan (2024) conducted an observational in Coronary artery disease requiring percutaneous coronary intervention (n=9,795,154). PCI for bifurcation lesions vs. PCI for non-bifurcation lesions was evaluated on Inpatient mortality (OR 1.68, 95% CI 1.49-1.88, p=<0.001). Percutaneous coronary intervention for bifurcation lesions was associated with significantly higher inpatient mortality compared to non-bifurcation lesions (adjusted OR 1.68).
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