SYNERGISTIC IMPACT OF CORONARY CALCIFICATION AND BIFURCATION TARGET LESIONS ON ADVERSE CARDIOVASCULAR EVENTS FOLLOWING PCI: INSIGHTS FROM A LARGE SINGLE-CENTER PCI REGISTRY

Background: Calcified coronary lesions and bifurcation lesions increase complexity of percutaneous coronary intervention (PCI). How much these parameters in combination affect post-PCI risk in the era of modern drug-eluting stents remains unknown. Methods: Registry data from 15,924 patients undergoing PCI with stents from January 2011 to December 2016 were analyzed. Patients were divided into four groups according to the presence or lack of lesion bifurcation and severity of lesion calcification (none/mild or moderate/severe). Outcomes including death, myocardial infarction (MI) and revascularization were analyzed at one year. Results: A total of 10,824 patients had PCI for non-bifurcation lesions with none/mild calcium; 2,659 patients had bifurcation lesions alone; 3,242 patients had moderate/severe calcification alone, and 801 patients had both lesion features. Analogous one-year MACE rates were 12.1%, 14.9%, 20.9% and 24.8%, respectively (Figure). Compared to patients without bifurcations and none/mild calcification, adjusted HR for MACE (95% CI) were 1.15 (0.98, 1.35), 1.45 (1.27, 1.65) and 1.60 (1.31, 1.90) in those with bifurcation lesions alone, moderate/severe calcium alone and both conditions. Similar trends in risk for MI, stent thrombosis and bleeding were seen. Conclusion Moderate or severely calcified lesions and bifurcation lesions have a synergistic impact on adverse events after PCI. New, standardized procedural strategies are needed to mitigate risk in such patients.