Burden, Management Strategies, and Clinical Outcomes of Coronary Bifurcation Lesions in Patients Undergoing Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction: A Retrospective Cohort Study

Abstract

Objective: This study aimed to determine the burden of coronary bifurcation lesions, evaluate contemporary management strategies, and identify predictors of six-month major adverse cardiac events (MACE) among patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). Methodology: This retrospective observational cohort study included 918 consecutive adult patients with STEMI who underwent primary PCI. Demographic, clinical, angiographic, procedural, and follow-up data were obtained from the institutional cardiovascular registry and hospital records. Coronary bifurcation lesions were identified angiographically, and bifurcation-specific procedural analyses were restricted to patients with bifurcation lesions. The primary outcome was six-month MACE. Results: The mean age of the study population was 62.71 ± 11.40 years, and 667 (72.7%) patients were male. Coronary bifurcation lesions were identified in 189 (20.6%) patients, of whom 101 (53.4%) had true bifurcation lesions. Among patients with bifurcation lesions, provisional single-stent PCI was performed in 134 (70.9%), whereas planned two-stent PCI was performed in 55 (29.1%) patients. During six months of follow-up, 115 (12.5%) patients experienced MACE, including target lesion revascularization in 57 (6.2%) and all-cause mortality in 51 (5.6%) patients. Independent predictors of six-month MACE were left main bifurcation involvement (OR 3.61, 95% CI 2.00–6.53; p<0.001), no-reflow phenomenon (OR 3.20, 95% CI 1.95–5.25; p<0.001), Killip class III/IV (OR 3.01, 95% CI 1.87–4.86; p<0.001), diabetes mellitus (OR 1.79, 95% CI 1.17–2.74; p=0.008), and increasing age (OR 1.03 per year, 95% CI 1.01–1.05; p=0.003). Conclusion: Approximately one in five STEMI patients undergoing primary PCI had coronary bifurcation lesions. Although provisional single-stent PCI was the predominant revascularization strategy, adverse clinical outcomes were primarily associated with lesion complexity and patient risk profile rather than procedural strategy. Left main bifurcation involvement, no-reflow, advanced Killip class, diabetes mellitus, and older age independently predicted six-month MACE.