Impact of Clinical and Lesion Features on Outcomes After Percutaneous Coronary Intervention in Bifurcation Lesions

Jeehoon Kang; Francesco Bruno; Tae-Min Rhee; Leonardo De Luca; Jung-Kyu Han; Ovidio de Filippo; Han-Mo Yang; Alessio Mattesini; Kyung Woo Park; Alessandra Truffa; Hyo-Soo Kim; Wojciech Wanha; Hyeon-Cheol Gwon; Sebastiano Gili; Woo Jung Chun; Gerard Helft; Seung-Ho Hur; Bernardo Cortese; Seung Hwan Han; Javier Escaned; Young Bin Song; Alaide Chieffo; Ki Hong Choi; Guglielmo Gallone; Joon-Hyung Doh; Gaetano De Ferrari; Soon-Jun Hong; Giorgio Quadri; Chang-Wook Nam; Bon-Kwon Koo; Fabrizio D'Ascenzo

doi:10.1016/j.jacasi.2022.05.003

Impact of Clinical and Lesion Features on Outcomes After Percutaneous Coronary Intervention in Bifurcation Lesions

JACC Asia. 2022 Sep 20;2(5):607-618. doi: 10.1016/j.jacasi.2022.05.003. eCollection 2022 Oct.

Authors

Jeehoon Kang¹, Francesco Bruno², Tae-Min Rhee¹, Leonardo De Luca³, Jung-Kyu Han¹, Ovidio de Filippo², Han-Mo Yang¹, Alessio Mattesini⁴, Kyung Woo Park¹, Alessandra Truffa⁵, Hyo-Soo Kim¹, Wojciech Wanha⁶, Hyeon-Cheol Gwon⁷, Sebastiano Gili⁸, Woo Jung Chun⁹, Gerard Helft¹⁰, Seung-Ho Hur¹¹, Bernardo Cortese¹², Seung Hwan Han¹³, Javier Escaned¹⁴, Young Bin Song⁷, Alaide Chieffo¹⁵, Ki Hong Choi⁷, Guglielmo Gallone², Joon-Hyung Doh¹⁶, Gaetano De Ferrari², Soon-Jun Hong¹⁷, Giorgio Quadri¹⁸, Chang-Wook Nam¹¹, Bon-Kwon Koo¹, Fabrizio D'Ascenzo²

Affiliations

¹ Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
² Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy.
³ Department of Cardiosciences, San Camillo-Forlanini Hospital, Roma, Italy.
⁴ Cardiologia Interventistica AOU Careggi, Florence, Italy.
⁵ Division of Cardiology, Cardinal Massaia, Ast, Italy.
⁶ Department of Cardiology, Medical University of Silesia, Katowice, Poland.
⁷ Department of Cardiology Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of Korea.
⁸ Division of Cardiology, Ospedale Monzino, Milan, Italy.
⁹ Department of Internal Medicine, Samsung Changwon Hospital, Changwon, Republic of Korea.
¹⁰ Pierre and Marie Curie University, Paris, France.
¹¹ Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea.
¹² Interventional Cardiology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy.
¹³ Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea.
¹⁴ Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain.
¹⁵ Division of Cardiology, Ospedale San Raffaele, Milan, Italy.
¹⁶ Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea.
¹⁷ Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Republic of Korea.
¹⁸ Division of Cardiology, Ospedale di Rivoli, Rivoli, Italy.

Abstract

Background: Bifurcation percutaneous coronary intervention (PCI) is associated with higher risk of clinical events.

Objectives: This study aimed to determine clinical and lesion features that predict adverse outcomes, and to evaluate the differential prognostic impact of these features in patients undergoing PCI for bifurcation lesions.

Methods: We analyzed 5,537 patients from the BIFURCAT (comBined Insights From the Unified RAIN and COBIS bifurcAtion regisTries) registry. The primary outcome was major adverse cardiac events (MACE) at 2-year follow-up; secondary outcomes included hard endpoints (all-cause death, myocardial infarction) and lesion-oriented clinical outcomes (LOCO) (target-vessel myocardial infarction, target lesion revascularization). The least absolute shrinkage and selection operator (LASSO) model was used for feature selection.

Results: During the 2-year follow-up period, MACE occurred in 492 patients (8.9%). The LASSO model identified 5 clinical features (old age, chronic renal disease, diabetes mellitus, current smoking, and left ventricular dysfunction) and 4 lesion features (left main disease, proximal main branch disease, side branch disease, and a small main branch diameter) as significant features that predict MACE. A combination of all 9 features improved the predictive value for MACE compared with clinical and lesion features (area under the receiver-operating characteristics curve: 0.657 vs 0.636 vs 0.581; P < 0.001). For secondary endpoints, the clinical features had a higher impact than lesion features on hard endpoints, whereas lesion features had a higher impact than clinical features on LOCO.

Conclusions: In bifurcation PCI, 9 features were associated with MACE. Clinical features were predominant predictors for hard endpoints, and lesion features were predominant for predicting LOCO. Clinical and lesion features have distinct values, and both should be considered in bifurcation PCI.

Keywords: bifurcation; clinical feature; feature selection; lesion feature; percutaneous coronary intervention.