Key result
High-risk ST resolution linked to ~5.8-fold higher cardiac death odds in bifurcation STEMI.
Why the study?
The relationship between the degree of ST-segment resolution and clinical outcomes after primary PCI of coronary bifurcation lesions in STEMI patients was not well defined.
Does the degree of ST-segment resolution and choice of bifurcation PCI strategy predict cardiac death and left ventricular ejection fraction in STEMI patients undergoing PPCI for bifurcation lesions?
Cohort (n=219)
No
Does the degree of ST-segment resolution and choice of bifurcation PCI strategy predict cardiac death and left ventricular ejection fraction in STEMI patients undergoing PPCI for bifurcation lesions?
Odds Ratio: 5.833 (95% CI 1.215–28.006)
Absolute Event Rate: 17.1% vs 4.3%
p-value: p=0.028
In STEMI patients undergoing primary PCI for bifurcation lesions, poor ST-segment resolution and a two-stent (main vessel plus side branch) strategy are independent predictors of long-term cardiac death and reduced ejection fraction.
May flag higher-risk STEMI patients after bifurcation PPCI; leaves open prospective validation before guiding risk stratification.
Background and Aims ST resolution (STR) is associated with improved cardiac outcomes after primary percutaneous coronary intervention (PPCI) and is a marker of success. In this study, we aimed to determine the relationship between the STR degree and outcomes after coronary bifurcation PPCI. Methods This cohort study was conducted at Sina Hospital, Tehran, Iran, from January 11, 2017, to March 20, 2022. Studied variables included age, sex, diabetes mellitus, hypertension, smoking, dyslipidemia, bifurcation type, bifurcation classification, PPCI strategy, type of MI, culprit vessel, door to device time, contrast volume, post PPCI thrombolysis in myocardial infarction, cardiac death, major adverse cardiovascukar events, type of stent, ejection fraction (EF), and STR. Follow‐up was performed for every patient from the PPCI date until November 2022 to 2022 November, with a 34 ± 25 (median ± IQR) months. STR was calculated as maximum ST elevation (max STE) from the 90 ‐min ECG after PPCI. Result EF in the low‐risk group was higher than in the medium‐ and high‐risk groups. Patients with inferior MI were at lower risk than those with anterior MI. The right coronary artery and left circumflex as the culprit vessels had a lower STR than the left anterior descending artery (LAD). Multiple logistic regression showed that PPCI in the main vessel (MV)/side branch (SB) increased cardiac death 6.43 times more than intervention in MV [OR: 4.637, 95% CI (1.021–21.055), p = 0.047]. Additionally, high‐risk STR increased the chance of cardiac death 5.83 times more than low‐risk [OR: 5.833, 95% CI (1.215–28.006), p = 0.028]. Medium‐risk STR and LAD as a culprit vessel were predictors of EF less than 50% [OR: 3.462, 95% CI (1.345–8.91), p = 0.01], [OR: 5.237, 95% CI (1.091–25.143), p = 0.039], respectively. Conclusion In bifurcation lesions, in addition to the STR, the MV/SB intervention strategy was another predictor of cardiac death. Also, STR was a predictor of EF.
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Mirzamohamadi et al. (2026) conducted a cohort in ST-elevation myocardial infarction (STEMI) with bifurcation lesions (n=219). High-risk ST-segment resolution (STR) vs. Low-risk ST-segment resolution (STR) was evaluated on Cardiac death (OR 5.833, 95% CI 1.215-28.006, p=0.028). High-risk ST-segment resolution significantly increased the odds of cardiac death compared to low-risk ST-segment resolution in STEMI patients undergoing bifurcation lesion PPCI (OR 5.833).
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