Differential Prognosis of True Bifurcation Lesions According to Left Main Versus Non–Left Main Location and Treatment Strategy
Background Although true bifurcation lesions are associated with a high risk of procedural complications, the differential prognostic implications of percutaneous coronary intervention for true bifurcations according to lesion location are unclear. This study aimed to identify whether clinical outco...
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2025-02-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.037657 |
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| author | Ki Hong Choi Chang‐Wook Nam Francesco Bruno Yun‐Kyeong Cho Leonardo De Luca Jeehoon Kang Alessio Mattesini Young Bin Song Alessandra Truffa Hyo‐Soo Kim Wojciech Wańha Woo Jung Chun Sebastiano Gili Gerard Helft Seung Hwan Han Bernardo Cortese Cheol Hyun Lee Javier Escaned Hyuck‐Jun Yoon Alaide Chieffo Joo‐Yong Hahn Guglielmo Gallone Seung‐Hyuk Choi Gaetano De Ferrari Bon‐Kwon Koo Giorgio Quadri Seung‐Ho Hur Fabrizio D'Ascenzo Hyeon‐Cheol Gwon Ovidio de Filippo |
| author_facet | Ki Hong Choi Chang‐Wook Nam Francesco Bruno Yun‐Kyeong Cho Leonardo De Luca Jeehoon Kang Alessio Mattesini Young Bin Song Alessandra Truffa Hyo‐Soo Kim Wojciech Wańha Woo Jung Chun Sebastiano Gili Gerard Helft Seung Hwan Han Bernardo Cortese Cheol Hyun Lee Javier Escaned Hyuck‐Jun Yoon Alaide Chieffo Joo‐Yong Hahn Guglielmo Gallone Seung‐Hyuk Choi Gaetano De Ferrari Bon‐Kwon Koo Giorgio Quadri Seung‐Ho Hur Fabrizio D'Ascenzo Hyeon‐Cheol Gwon Ovidio de Filippo |
| author_sort | Ki Hong Choi |
| collection | DOAJ |
| description | Background Although true bifurcation lesions are associated with a high risk of procedural complications, the differential prognostic implications of percutaneous coronary intervention for true bifurcations according to lesion location are unclear. This study aimed to identify whether clinical outcomes of true bifurcation lesions differed between left main coronary artery (LM) and non‐LM bifurcations and to determine the optimal treatment strategy for subtypes of bifurcation lesions in the current‐generation drug‐eluting stent era. Methods The ULTRA‐BIFURCAT (Combined Insights From the Unified COBIS III, RAIN, and ULTRA Registries) was created by merging 3 bifurcation‐dedicated registries from Korea and Italy. For this, 6548 patients treated with bifurcation lesions were stratified by lesion location and subtype. The primary end point was major adverse cardiac events (MACEs; composite of all‐cause death, myocardial infarction, target lesion revascularization, and stent thrombosis) at 800 days. Results In patients with an LM bifurcation, those with a true bifurcation had a significantly higher risk of a MACE than those with a nontrue bifurcation (20.2% versus 13.4%, adjusted hazard ratio [HR], 1.44 [95% CI, 1.11–1.86]; P=0.006). Conversely, there was no significant difference in the risk of a MACE according to true versus nontrue bifurcation in patients with non‐LM bifurcation lesions (9.0% versus 8.8%; adjusted HR, 1.02 [95% CI, 0.82–1.27]; P=0.849). For LM true bifurcations, MACE rates were comparable between 1‐stent and 2‐stent strategies, whereas for LM nontrue bifurcations, the 2‐stent strategy was associated with a significantly higher risk of MACEs than the 1‐stent strategy. No significant differences in the risk of MACEs were observed in non‐LM bifurcation lesions according to lesion subtype or treatment strategy. Conclusions Clinical outcomes were worse for LM true bifurcation lesions than non‐LM true bifurcation lesions. A provisional 1‐stent strategy should be the preferred approach for treating LM nontrue bifurcation lesions. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03068494, NCT03544294, and NCT05205148. |
| format | Article |
| id | doaj-art-dce27402b1be44e3972c98c513084052 |
| institution | Kabale University |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-dce27402b1be44e3972c98c5130840522025-02-04T11:00:01ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-02-0114310.1161/JAHA.124.037657Differential Prognosis of True Bifurcation Lesions According to Left Main Versus Non–Left Main Location and Treatment StrategyKi Hong Choi0Chang‐Wook Nam1Francesco Bruno2Yun‐Kyeong Cho3Leonardo De Luca4Jeehoon Kang5Alessio Mattesini6Young Bin Song7Alessandra Truffa8Hyo‐Soo Kim9Wojciech Wańha10Woo Jung Chun11Sebastiano Gili12Gerard Helft13Seung Hwan Han14Bernardo Cortese15Cheol Hyun Lee16Javier Escaned17Hyuck‐Jun Yoon18Alaide Chieffo19Joo‐Yong Hahn20Guglielmo Gallone21Seung‐Hyuk Choi22Gaetano De Ferrari23Bon‐Kwon Koo24Giorgio Quadri25Seung‐Ho Hur26Fabrizio D'Ascenzo27Hyeon‐Cheol Gwon28Ovidio de Filippo29Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of KoreaDivision of Cardiology, Department of Internal Medicine Keimyung University Dongsan Hospital Daegu Republic of KoreaDepartment of Internal Medicine Città della Salute e della Scienza Turin ItalyDivision of Cardiology, Department of Internal Medicine Keimyung University Dongsan Hospital Daegu Republic of KoreaDivision of Cardiology Fondazione IRCCS Policlinico San Matteo Pavia ItalyDepartment of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Republic of KoreaCardiologia Interventistica AOU Careggi Florence ItalyDivision of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of KoreaDivision of Cardiology Cardinal Massaia Ast ItalyDepartment of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Republic of KoreaCardiology and Structural Heart Diseases Medical University of Silesia Katowice PolandDepartment of Internal Medicine Samsung Changwon Hospital Changwon Republic of KoreaDivision of Cardiology Ospedale Monzino Milan ItalyINSERM UMRS1166, Hôpital Pitié‐Salpêtrière (AP‐HP) Sorbonne Université Paris FranceDepartment of Internal Medicine Gachon University Gil Hospital Incheon Republic of KoreaDCB Academy Milan ItalyDepartment of Internal Medicine Città della Salute e della Scienza Turin ItalyHospital Clínico San Carlos IDISSC, and Universidad Complutense de Madrid Madrid SpainDepartment of Internal Medicine Città della Salute e della Scienza Turin ItalyDivision of Cardiology Ospedale San Raffaele Milan ItalyDivision of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of KoreaDepartment of Internal Medicine Città della Salute e della Scienza Turin ItalyDivision of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of KoreaDepartment of Internal Medicine Città della Salute e della Scienza Turin ItalyDepartment of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Republic of KoreaDivision of Cardiology Ospedale di Rivoli Rivoli ItalyDivision of Cardiology, Department of Internal Medicine Keimyung University Dongsan Hospital Daegu Republic of KoreaDepartment of Internal Medicine Città della Salute e della Scienza Turin ItalyDivision of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of KoreaDepartment of Internal Medicine Città della Salute e della Scienza Turin ItalyBackground Although true bifurcation lesions are associated with a high risk of procedural complications, the differential prognostic implications of percutaneous coronary intervention for true bifurcations according to lesion location are unclear. This study aimed to identify whether clinical outcomes of true bifurcation lesions differed between left main coronary artery (LM) and non‐LM bifurcations and to determine the optimal treatment strategy for subtypes of bifurcation lesions in the current‐generation drug‐eluting stent era. Methods The ULTRA‐BIFURCAT (Combined Insights From the Unified COBIS III, RAIN, and ULTRA Registries) was created by merging 3 bifurcation‐dedicated registries from Korea and Italy. For this, 6548 patients treated with bifurcation lesions were stratified by lesion location and subtype. The primary end point was major adverse cardiac events (MACEs; composite of all‐cause death, myocardial infarction, target lesion revascularization, and stent thrombosis) at 800 days. Results In patients with an LM bifurcation, those with a true bifurcation had a significantly higher risk of a MACE than those with a nontrue bifurcation (20.2% versus 13.4%, adjusted hazard ratio [HR], 1.44 [95% CI, 1.11–1.86]; P=0.006). Conversely, there was no significant difference in the risk of a MACE according to true versus nontrue bifurcation in patients with non‐LM bifurcation lesions (9.0% versus 8.8%; adjusted HR, 1.02 [95% CI, 0.82–1.27]; P=0.849). For LM true bifurcations, MACE rates were comparable between 1‐stent and 2‐stent strategies, whereas for LM nontrue bifurcations, the 2‐stent strategy was associated with a significantly higher risk of MACEs than the 1‐stent strategy. No significant differences in the risk of MACEs were observed in non‐LM bifurcation lesions according to lesion subtype or treatment strategy. Conclusions Clinical outcomes were worse for LM true bifurcation lesions than non‐LM true bifurcation lesions. A provisional 1‐stent strategy should be the preferred approach for treating LM nontrue bifurcation lesions. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03068494, NCT03544294, and NCT05205148.https://www.ahajournals.org/doi/10.1161/JAHA.124.037657Medina classificationoutcomespercutaneous coronary interventionstent techniquetrue bifurcation |
| spellingShingle | Ki Hong Choi Chang‐Wook Nam Francesco Bruno Yun‐Kyeong Cho Leonardo De Luca Jeehoon Kang Alessio Mattesini Young Bin Song Alessandra Truffa Hyo‐Soo Kim Wojciech Wańha Woo Jung Chun Sebastiano Gili Gerard Helft Seung Hwan Han Bernardo Cortese Cheol Hyun Lee Javier Escaned Hyuck‐Jun Yoon Alaide Chieffo Joo‐Yong Hahn Guglielmo Gallone Seung‐Hyuk Choi Gaetano De Ferrari Bon‐Kwon Koo Giorgio Quadri Seung‐Ho Hur Fabrizio D'Ascenzo Hyeon‐Cheol Gwon Ovidio de Filippo Differential Prognosis of True Bifurcation Lesions According to Left Main Versus Non–Left Main Location and Treatment Strategy Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease Medina classification outcomes percutaneous coronary intervention stent technique true bifurcation |
| title | Differential Prognosis of True Bifurcation Lesions According to Left Main Versus Non–Left Main Location and Treatment Strategy |
| title_full | Differential Prognosis of True Bifurcation Lesions According to Left Main Versus Non–Left Main Location and Treatment Strategy |
| title_fullStr | Differential Prognosis of True Bifurcation Lesions According to Left Main Versus Non–Left Main Location and Treatment Strategy |
| title_full_unstemmed | Differential Prognosis of True Bifurcation Lesions According to Left Main Versus Non–Left Main Location and Treatment Strategy |
| title_short | Differential Prognosis of True Bifurcation Lesions According to Left Main Versus Non–Left Main Location and Treatment Strategy |
| title_sort | differential prognosis of true bifurcation lesions according to left main versus non left main location and treatment strategy |
| topic | Medina classification outcomes percutaneous coronary intervention stent technique true bifurcation |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.037657 |
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