Key result
Medina 0-0-1 lesions are linked to ~4-fold higher 1-year MACE risk vs. 0-1-0 bifurcations.
Why the study?
The impact of Medina classification-based coronary bifurcation lesion distribution on outcomes of imaging-guided bifurcation stenting was unclear.
Does the Medina classification subtype impact 1-year clinical outcomes in patients undergoing imaging-guided coronary bifurcation stenting?
Observational (n=769)
Yes
Does the Medina classification subtype impact 1-year clinical outcomes in patients undergoing imaging-guided coronary bifurcation stenting?
Under intracoronary imaging guidance, clinical outcomes are comparable between true and non-true coronary bifurcation lesions, with the exception of isolated side-branch (Medina 0-0-1) lesions which carry a significantly elevated risk of MACE and target lesion revascularization.
Isolated side-branch lesions may need intensified surveillance after imaging-guided stenting; extends bifurcation classification data but remains hypothesis-generating.
Background: Intracoronary imaging improves clinical outcomes after stenting of complex coronary bifurcation lesions (CBLs), but the impact of Medina classification-based CBL distribution on outcomes of imaging-guided bifurcation stenting is unclear. Methods: In this integrated analysis of four previous studies, in which all CBLs were treated with drug-eluting stents under intravascular ultrasound or optical coherence tomography guidance, the distribution of 763 CBLs was assessed using angiographic Medina classification. Major adverse cardiac events (MACE), including target lesion revascularization (TLR), myocardial infarction, stent thrombosis, and cardiac death, were investigated at 1-year follow-up. Results: The most and least prevalent Medina subtypes were 0-1-0 (27.9 %) and 0-0-1 lesions (2.8 %). The most and least frequent MACE/TLR rates were 18.2 %/18.2 % for 0-0-1 lesions and 4.1 %/2.8 % for 0-1-0 lesions. Risks were higher for 0-0-1 lesions than for 0-1-0 lesions for both MACE (hazard ratio [HR]: 4.04, 95 % confidence interval [CI]: 1.21-13.45, p = 0.02) and TLR (HR: 6.19, 95 % CI: 1.69-22.74, p = 0.006). MACE rates were similar for true and non-true CBLs excluding 0-0-1 lesions (8.2 % and 5.9 %, HR 1.54, 95 % CI: 0.86-2.77, p = 0.15), while MACE (HR: 3.25, 95 % CI: 1.10-9.63, p = 0.03) and TLR (HR: 4.24, 95 % CI: 1.38-12.96, p = 0.01) risks were higher for 0-0-1 lesions. Conclusions: This integrated analysis of imaging-guided bifurcation stenting demonstrated similar clinical outcomes in true and non-true CBLs, except for 0-0-1 lesions, which had a significantly higher risk of MACE/TLR.
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Murasato et al. (2023) conducted an observational in Coronary bifurcation lesions (n=769). Medina 0-0-1 lesion classification vs. Medina 0-1-0 lesion classification was evaluated on Major adverse cardiac events (MACE) (HR 4.04, 95% CI 1.21-13.45, p=0.02). In patients undergoing imaging-guided coronary bifurcation stenting, Medina 0-0-1 lesions had a significantly higher risk of 1-year major adverse cardiac events compared to 0-1-0 lesions (18.2% vs 4.1%; HR 4.04).
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