Key result
Medina 1.1.1 and 0.0.1 bifurcation lesions linked to up to ~300% higher 1-year TLF versus 1.0.0.
Why the study?
Coronary bifurcation lesions are common and linked to worse PCI outcomes, but data on prognostic impact of different Medina classifications are limited.
Does the Medina classification subtype predict 1-year target lesion failure in patients undergoing percutaneous coronary intervention for coronary bifurcation lesions?
Observational (n=4,003)
Yes
Does the Medina classification subtype predict 1-year target lesion failure in patients undergoing percutaneous coronary intervention for coronary bifurcation lesions?
Hazard Ratio: 2.6 (95% CI 1.3–5.5)
In patients undergoing PCI for coronary bifurcation lesions, Medina 1.1.1 and 0.0.1 subtypes are associated with a significantly higher risk of 1-year target lesion failure compared to the Medina 1.0.0 subtype.
May identify higher-risk bifurcation PCI patients for closer surveillance; hypothesis-generating for subtype-specific strategies.
Background Coronary bifurcation lesions (CBLs) are frequently encountered in clinical practice and are associated with worse outcomes after percutaneous coronary intervention. However, there are limited data around the prognostic impact of different CBL distributions. Methods and Results All CBL percutaneous coronary intervention procedures from the prospective e-Ultimaster (Prospective, Single-Arm, Multi Centre Observations Ultimaster Des Registry) multicenter international registry were analyzed according to CBL distribution as defined by the Medina classification. Cox proportional hazards models were used to compare the hazard ratio (HR) of the primary outcome, 1-year target lesion failure (composite of cardiac death, target vessel-related myocardial infarction, and clinically driven target lesion revascularization), and its individual components between Medina subtypes using Medina 1.0.0 as the reference category. A total of 4003 CBL procedures were included. The most prevalent Medina subtypes were 1.1.1 (35.5%) and 1.1.0 (26.8%), whereas the least prevalent was 0.0.1 (3.5%). Overall, there were no significant differences in patient and procedural characteristics among Medina subtypes. Only Medina 1.1.1 and 0.0.1 subtypes were associated with increased target lesion failure (HR, 2.6 [95% CI, 1.3-5.5] and HR, 4.0 [95% CI, 1.6-9.0], respectively) at 1 year, compared with Medina 1.0.0, prompted by clinically driven target lesion revascularization (HR, 3.1 [95% CI, 1.1-8.6] and HR, 4.6 [95% CI, 1.3-16.0], respectively) as well as cardiac death in Medina 0.0.1 (HR, 4.7 [95% CI, 1.0-21.6]). No differences in secondary outcomes were observed between Medina subtypes. Conclusions In a large multicenter registry analysis of coronary bifurcation percutaneous coronary intervention procedures, we demonstrate prognostic differences in 1-year outcomes between different CBL distributions, with Medina 1.1.1 and 0.0.1 subtypes associated with an increased risk of target lesion failure.
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Mohamed et al. (2022) conducted an observational in Coronary bifurcation lesions (n=4,003). Medina 1.1.1 and 0.0.1 subtypes vs. Medina 1.0.0 subtype was evaluated on 1-year target lesion failure (composite of cardiac death, target vessel-related myocardial infarction, and clinically driven target lesion revascularization) (HR 2.6, 95% CI 1.3-5.5). Medina 1.1.1 and 0.0.1 coronary bifurcation lesion subtypes were associated with increased 1-year target lesion failure compared with Medina 1.0.0 (HR 2.6, 95% CI 1.3-5.5 and HR 4.0, 95% CI 1.6-9.0).
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