Development of a Novel BifurcAID Risk Score to Predict MACE Following Coronary True Bifurcation Intervention

Background: Percutaneous coronary intervention (PCI) for true bifurcation lesions is associated with a higher risk of adverse clinical events. Objectives: This study sought to establish a point-based score using clinical and angiographic characteristics in true bifurcation lesions before PCI to predict the risk of major adverse cardiovascular events (MACE). Methods: A total of 1,896 consecutive patients undergoing PCI for true bifurcation lesions between 2012 and 2019 in our institution were included. All angiograms were reviewed by an independent core laboratory for classification of the bifurcation lesions. A multivariate model identified factors associated with 1-year MACE, comprising all-cause death, myocardial infarction, and target vessel revascularization. Points were assigned to each risk factor proportional to their regression coefficients to create a cumulative risk score. The score was used to stratify patients into low-, intermediate-, and high-risk cohorts. Results: At 1-year post-PCI, MACE occurred in 185 patients (9.8%). Eleven predictors of MACE were identified: 5 clinical (insulin-dependent diabetes mellitus, left ventricular ejection fraction ≤30%, non–ST-segment elevation myocardial infarction presentation, age >80 years, and non-white race/ethnicity), and 6 angiographic (left main or left circumflex-obtuse marginal coronary artery lesion, multivessel disease, side branch [SB] thrombus, SB moderate/severe calcium, and SB lesion length >10 mm). The rate of MACE was 4.9% in low-risk patients with a risk score 0 to 6 (reference group), 12.9% in intermediate-risk patients with a score 7 to 9 (OR: 2.63; 95% CI: 1.74-3.98; P < 0.001), and 25.4% in high-risk group with a score ≥10 (OR: 5.18; 95% CI: 3.56-7.53; P < 0.001). Conclusions: The BifurcAID risk score may facilitate risk stratification among patients undergoing true bifurcation PCI and guide patient-tailored treatment strategies.