Ten‐Year Trends in Coronary Bifurcation Percutaneous Coronary Intervention: Prognostic Effects of Patient and Lesion Characteristics, Devices, and Techniques
Year: 2021
Type: article
Study design: Observational Study
Abstract: Background Despite advances in devices and techniques, coronary bifurcation lesion remains a challenging lesion subset in the field of percutaneous coronary intervention (PCI). We evaluate 10‐year trends in bifurcation PCI and their effects on patient outcomes. Methods and Results We analyzed 10‐year trends in patient/lesion characteristics, devices, PCI strategy, stent optimization techniques, and clinical outcomes using data from 5498 patients who underwent bifurcation PCI from 2004 to 2015. Clinical outcomes 2 years after the index procedure were evaluated in terms of target vessel failure (a composite of cardiac death, myocardial infarction, and target vessel revascularization) and a patient‐oriented composite outcome (a composite of all‐cause death, myocardial infarction, and any revascularization). During the 10‐year study period, patient and lesion complexity, such as multivessel disease, diabetes mellitus, chronic kidney disease, and left main bifurcation, increased continuously (all P <0.001). The risk of target vessel failure or patient‐oriented composite outcome decreased continuously from 2004 to 2015 (target vessel failure: from 12.3% to 6.9%, log‐rank P <0.001; patient‐oriented composite outcome: from 13.6% to 9.3%, log‐rank P <0.001). The use of a second‐generation drug‐eluting stent and decreased target vessel failure risk in true bifurcation lesions were the major contributors to improved patient prognosis (interaction P values were <0.001 and 0.013, respectively). Conclusions During the past decade of bifurcation PCI, patient and lesion characteristics, devices, PCI techniques, and patient prognosis have all significantly changed. Despite increased patient and lesion complexity, clinical outcomes after bifurcation PCI have improved, mainly because of better devices and more widespread adoption of procedural optimization techniques and appropriate treatment strategies. Registration URL: https://www.clinicaltrials.gov ; Unique identifiers: NCT01642992 and NCT03068494.
Authors: Joo Myung Lee, Seung Hun Lee, Juwon Kim, Ki Hong Choi, Taek Kyu Park, Jeong Hoon Yang, Young Bin Song, Joo‐Yong Hahn, Jin‐Ho Choi, Seung‐Hyuk Choi, Hyo‐Soo Kim, Woo Jung Chun, Chang‐Wook Nam, Seung‐Ho Hur, Seung Hwan Han, Seung‐Woon Rha, In‐Ho Chae, Jin‐Ok Jeong, Jung Ho Heo, Junghan Yoon, Do‐Sun Lim, Jong‐Seon Park, Myeong‐Ki Hong, Joon‐Hyung Doh, Kwang Soo Cha, Doo‐Il Kim, Sang Yeub Lee, Kiyuk Chang, Byung‐Hee Hwang, So‐Yeon Choi, Myung Ho Jeong, Soon‐Jun Hong, Bon‐Kwon Koo, Hyeon‐Cheol Gwon
Institutions: Samsung Medical Center, Sungkyunkwan University, Chonnam National University, Chungbuk National University, Chonnam National University Hospital, Chungbuk National University Hospital, Ajou University Hospital, Seoul National University Hospital, Samsung Changwon Hospital, Keimyung University Dongsan Medical Center, Keimyung University Dongsan Hospital, Gachon University Gil Medical Center, Korea University Guro Hospital, Seoul National University Bundang Hospital, Chungnam National University Hospital, Kosin University Gospel Hospital, Kosin University, Yonsei University, Wonju Severance Christian Hospital, Korea University Anam Hospital, Yeungnam University Medical Center, Yeungnam University, Severance Hospital, Inje University Ilsan Paik Hospital, Pusan National University Hospital, Inje University Haeundae Paik Hospital, The Catholic University of Korea Seoul St. Mary's Hospital, Catholic University of Korea, St. Paul's Hospital
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,025
Funders: Seoul National University Bundang Hospital, Korea University Guro Hospital, Chonnam National University, Chungbuk National University, Chungnam National University, Keimyung University, Kosin University, Pusan National University, Seoul National University, Yonsei University, Ajou University, Gachon University, Inje University, Sungkyunkwan University, Catholic University of Korea, Yeungnam University, College of Medicine, Koisin University, Seoul National University Hospital, Gil Medical Center, Gachon University, Chungnam National University Hospital, Pusan National University Hospital, Korea University Anam Hospital, Samsung, Yonsei University College of Medicine, Seoul St. Mary's Hospital, Catholic University of Korea
OpenAlex ID: W3201248115