Mini-crush versus provisional stenting in coronary bifurcation lesions: long-term results from a real-world cohort

BACKGROUND: The optimal stenting strategy for coronary bifurcation lesions remains a topic of debate, particularly regarding the long-term comparative effectiveness of mini-crush and provisional techniques. METHODS: We analysed consecutive patients undergoing bifurcation percutaneous coronary intervention (PCI) treated with either provisional stenting or a planned mini-crush strategy. True bifurcation lesions were classified according to the Medina classification, and only those with lesions classified as 1.1.1, 1.0.1, and 0.1.1 were included. The primary endpoint was a composite of all-cause mortality and target lesion revascularisation (TLR). Time-to-event outcomes were assessed using the Kaplan-Meier method and compared using the log-rank test. Multivariable Cox proportional hazards regression was performed to identify independent predictors of outcomes. A prespecified subgroup analysis was conducted for patients with true bifurcation lesions (Medina 1.1.1). RESULTS: A total of 157 patients (92 with provisional stenting and 65 with mini-crush) were included, with a median follow-up exceeding seven years. Event-free survival did not differ significantly between the two techniques (log-rank p = 0.738). In multivariable analysis, after adjusting for age, prior PCI, multivessel disease, and lesion complexity, the stenting technique was not independently associated with the composite endpoint (adjusted HR 1.05, 95% CI 0.49-2.27; p = 0.90). In the Medina 1.1.1 subgroup, long-term mortality and TLR rates were also comparable across strategies. CONCLUSION: In our real-world cohort, both mini-crush and provisional stenting strategies were associated with similar long-term clinical outcomes. After adjusting for patient and lesion complexity, the stenting technique did not predict long-term prognosis, suggesting that anatomical and clinical factors may outweigh procedural strategy in bifurcation PCI.