Percutaneous coronary intervention in bifurcation lesions: independent predictors of in-hospital death

Abstract

Background: Bifurcation lesions remain a challenge and little is known about the characteristics and outcomes of percutaneous coronary intervention over the last decade with the increasing use of drug-eluting stents. The objective of this study was to identify the patient profile and the in-hospital outcomes as well as the predictors of in-hospital death over time. Methods: An observational, retrospective study that evaluated patients undergoing percutaneous coronary intervention for bifurcation lesions between 2006 and 2016. Patients were divided into three groups: 2006-2008 (Group 1), 2009-2011 (Group 2), and 2012-2016 (Group 3). We used multiple logistic regression analysis to identify independent predictors of in-hospital death. Results: A total of 36,608 patients were included, and Group 3 patients were older, with a higher number of comorbidities, more stable clinical presentation and lesions treated with longer stent length and smaller stent size. The success of the procedure was higher (96.1% vs. 97.4% vs. 98.1%; p<0.0001) and the mortality lower (1.2% vs. 0.7% vs. 0.6%; p<0.0001) in the most recently treated group. In the multiple logistic regression analysis, female sex, left main coronary artery lesions, primary percutaneous coronary intervention, rescue percutaneous coronary intervention, procedures performed between 2006-2008 and use of glycoprotein IIb/IIIa inhibitors were variables independently associated with in-hospital mortality. Conclusions: Female sex, acute clinical presentation, emergency percutaneous coronary intervention, and greater anatomical complexity were associated with in-hospital mortality in patients undergoing coronary bifurcation treatment. Advances in contemporary treatment possibly contributed to the clinical outcome improvement in these patients.