Bifurcation PCI in Patients With Versus Without Acute Coronary Syndrome: Insights From the PROGRESS-BIFURCATION Registry

Abstract

BACKGROUND The outcomes of bifurcation percutaneous coronary intervention (PCI) in patients with acute coronary syndromes (ACS) have received limited study.METHODS We examined the clinical, procedural characteristics and outcomes of 1,072 patients (1,221 bifurcation PCIs) performed at 5 centers between 2013 and 2023 in the PROGRESS-BIFURCATION (Prospective Global Registry for the Study of Bifurcation Lesion Interventions). RESULTS of the 1,072 patients, 583 (54.4%) presented with ACS. ACS patients were more likely to be women (29.0% vs 21.3%; P ¼ 0.004), have diabetes (38.4% vs 29.7%; P ¼ 0.003) and cerebrovascular disease (14.2% vs 9.8%; P ¼ 0.029) and less likely to have had a prior PCI (43.7% vs 49.9%; P ¼ 0.044). ACS patients had greater proximal leftanterior descending (70.0% vs 60.0%; P < 0.001) and distal left main diameter stenosis (82.5% vs 80.0%; P < 0.001) and required less contrast, fluoroscopy time, radiation, and procedure time. There was no difference in technical success (94.9% vs 95.3%; P ¼ 0.775). After adjusting for confounders, ACS patients were more likely to have an in-hospital major adverse cardiovascular event (MACE) (OR: 2.32; CI: 1.07-5.04; P ¼ 0.034). During a median follow-up of 37 months ACS presentation was independently associated with follow-up MACE (HR: 1.52; CI: 1.04-2.22; P ¼ 0.032), myocardial infarction (HR: 2.68; CI: 1.14-6.32; P ¼ 0.024), and death (HR: 2.35; CI: 1.36-4.07; P ¼ 0.003). CONCLUSION ACS patients undergoing bifurcation PCI had worse inhospital and follow-up outcomes compared with chronic coronary syndrome patients.