Impact of Calcium on the Long-Term Outcomes of Bifurcation Percutaneous Coronary Intervention (PROGRESS-BIFURCATION)

Abstract

BACKGROUND Coronary calcification of bifurcation lesions is common.METHODS We examined the impact of calcium on the long-term outcomes of 1,307 bifurcation PCIs (1,135 patients) performed at 5 centers from 2013 to 2024 from the PROGRESS-BIFURCATION registry.RESULTS Main vessel (MV) moderate/severe calcification was present in 40.4% of the bifurcation lesions. Patients whose lesions were moderately/severely calcified were older with more comorbidities. Their proximal MV was more likely to be the left main coronary artery, and they had higher proximal MV lesion length and diameter stenosis. Most (89.39%) of the moderately/severely calcified lesions used one/more lesion preparation techniques, mainly compliant (70.3%) and noncompliant balloons (48.5%). Moderately/severely calcified bifurcations had similar technical success (94.1% vs 95.6%; P ¼ 0.219) and in-hospital major adverse cardiac events (MACE) (5.3% vs 3.5%; P ¼ 0.156). Follow-up was available for 777 patients (median: 1,095 days; Q1-Q3: 484-1,962 days). The incidences of follow-up MACE (37.9% vs 28.4%; P ¼ 0.006), death (22.0% vs 12.4%; P < 0.001), andtarget vessel revascularization (TVR) (14.2% vs 8.8%; P ¼ 0.017) were higher in moderately/severely calcified bifurcations, and the association for follow-up MACE (HR: 1.49; 95% CI: 1.08-2.07; P ¼ 0.016) and TVR (HR: 1.79; 96% CI 1.09-2.95; P ¼ 0.022) persisted on adjusted mixed Cox proportional hazards analysis CONCLUSIONS PCI of moderately/severely calcified bifurcation lesions has high success rates but is associated with high follow-up MACE, death, and TVR.