Bifurcation Coronary Intervention is Associated with Higher Mortality and Complications

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 with bifurcation lesion PCI were compared to other PCIs excluding chronic total occlusions (CTO). We evaluated post-procedural inpatient mortality and complications. Results PCI in patients with a bifurcation lesion was associated with higher mortality and post-procedural complications. A weighted total of 9,795,154 patients underwent PCI, with 43,480 having a bifurcation lesion. The bifurcation group had a 3.79% mortality rate vs 2.56%. (OR, 1.50; CI:1.34–1.68; p<0.001). After adjusting for age, sex, race, diabetes mellitus, and chronic kidney disease, bifurcation lesion PCI remained significantly associated with higher mortality (OR, 1.68; 95% CI, 1.49– 1.88; p<0.001). Furthermore, bifurcation PCI 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). All post-procedural complications were more than 4 times more likely in patients with bifurcation than in those without (OR, 4.33; 95% CI, 3.83-4.88; p<0.001). Conclusion Using a large national inpatient database, PCI performed in patients with a Non-CTO bifurcation lesions were associated with significantly higher mortality and post-procedural complications.