Admission neutrophil-to-lymphocyte ratio and target-vessel failure after bifurcation percutaneous coronary intervention in acute coronary syndrome

BACKGROUND: Coronary bifurcation lesions represent one of the most complex settings in patients with acute coronary syndrome (ACS) and are associated with worse outcomes after percutaneous coronary intervention (PCI). In addition to anatomical complexity, systemic inflammation may influence long-term vessel-related outcomes. The neutrophil-to-lymphocyte ratio (NLR) is a simple marker of inflammatory burden, but its prognostic value in ACS patients undergoing bifurcation PCI remains unclear. METHODS: This retrospective single-centre study included ACS patients treated with bifurcation PCI using a two-stent strategy between 2022 and 2025. Target-vessel failure (TVF) was defined as a composite of cardiac death, target-vessel-related myocardial infarction, and repeat target-vessel revascularisation. Independent predictors of TVF were evaluated using multivariable logistic regression. RESULTS: A total of 106 patients were included, with a median follow-up of 29 months. TVF occurred in 22 patients (20.8%). Patients with TVF had significantly higher NLR values and higher SYNTAX scores. In multivariable analysis, both NLR and SYNTAX score remained independently associated with TVF. CONCLUSION: In ACS patients undergoing bifurcation PCI, increased inflammatory burden reflected by NLR and greater coronary complexity are independently associated with TVF, supporting the use of combined inflammatory and angiographic risk assessment after PCI.