Impact of Clinical and Lesion Features on Outcomes After Percutaneous Coronary Intervention in Bifurcation Lesions

Figure 1. Overview of the BIFURCAT Registry A total of 5,537 patient were included (2,648 from the COBIS III registry and 2,889 from the RAIN registry) in the current analysis. All patients underwent percutaneous coronary intervention for bifurcation lesions with second-generation drug-eluting stents. BIFURCAT = comBined Insights From the Unified RAIN and COBIS bifurcAtion regisTries; COBIS = Coronary Bifurcation Stenting Registry; RAIN = VeRy Thin Stents for Patients With Left mAIn or bifurcatioN in Real Life.

Figure 2. Feature Selection Using the LASSO Cox Regression Model From a total of 18 clinical and lesion features, 5 clinical features (old age, chronic renal disease, diabetes mellitus, current smoking, and LV dysfunction) and 4 lesion features (LM disease, proximal MB disease, SB disease, and a small MB diameter), which could derive the maximum AUC and minimum MSE were selected. ACS = acute coronary syndrome; AUC = area under the curve; LASSO = least absolute shrinkage and selection operator; LM = left main; LV = left ventricular; MB = main branch; MSE = mean square error; SB = side branch.

Figure 3. Predictive Value of the Combined Clinical and Lesion Risk (A) Comparison of the predictive value of the combined risk, clinical risk, and lesion risk using the AUC value for MACE. (B) The population was divided into tertiles based on the number of risk features (low-risk group [number of risk features ≤2], moderate-risk group [number of risk features = 3], high-risk group [number of risk features ≥4]), and the Kaplan-Meier survival curve presented that patients in a higher-risk group had a significantly higher risk of MACE. AUC = area under the curve; MACE = major adverse cardiac events.

Figure 4. Number of Clinical/Lesion Features and the Risk for Adverse Outcomes The risk for hard endpoints and lesion-oriented composite outcome increased along with the number of clinical and lesion features.

Figure 5. Adverse Outcomes by 2-by-2 Combination of High/Low Clinical/Lesion Risk Adverse outcome rate for (A) hard endpoints and (B) lesion-oriented composite outcome in 4 groups (group 1: low clinical risk and low lesion risk; group 2: low clinical risk and high lesion risk; group 3: high clinical risk and low lesion risk; group 4: high clinical risk and high lesion risk).

Central Illustration. Differential Impact of Clinical/Lesion Predictors of Major Adverse Cardiac Events on Representative Outcomes The BIFURCAT registry, which included 5,537 patients who received percutaneous coronary intervention for bifurcation lesions with second-generation drug-eluting stent, was analyzed. The LASSO Cox regression model derived 5 clinical features and 4 lesion features as important features that determine major adverse cardiac events. Clinical features had a higher impact on the hard endpoint (all-cause death, myocardial infarction), and lesion features had a higher impact on lesion-oriented clinical outcomes (target-vessel myocardial infarction, target lesion revascularization). AUC = area under the curve; BIFURCAT = comBined Insights From the Unified RAIN and COBIS bifurcAtion regisTries; DES = drug-eluting stent; LASSO = least absolute shrinkage and selection operator; LM = left main; LV = left ventricular; MACE = major adverse cardiac events; MB = main branch; PCI = percutaneous coronary intervention; SB = side branch.