P4589The prognostic impact of the Medina classification in bifurcation lesion percutaneous coronary intervention

• Published in: European heart journal Vol. 40; no. Supplement_1
• Main Authors: Perl, L, Witberg, G, Vaknin-Assa, H, Kornowski, R, Assali, A
• Format: Journal Article
• Language: English
• Published: Oxford University Press 01-10-2019
• Subjects: Coronary Artery Disease: Treatment, Revascularization
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehz745.0974

Abstract
Background/Introduction
The Medina classification is the most widespread method to describe bifurcation lesions. However, little is known regarding the prognostic impact of the classification.
Purpose
To assess the prognostic significance of the Medina classification following percutaneous coronary intervention (PCI).
Methods
The study included 738 consecutive patients from a prospective bifurcation registry. There were 609 patients (82.5%) with “true bifurcation” (TB) lesions (Medina class 1.0.1, 1.1.1, 0.1.1) and 129 (17.5%) in all other categories (“non-true bifurcation” = NTB). We compared rates of death and major adverse cardiac events (MACE: cardiac death, myocardial infarction, or target vessel revascularization) at 12 months and 3 years.
Results
Patients with TB had lower rates of previous bypass surgery (9.4% vs. 12.2%, p=0.03) and hyperlipidemia (75.2% vs. 79.0%, p=0.04). TB lesions were more likely to be calcified (33.8% vs. 28.2%, p=0.03) and ulcerated (8.9% vs. 3.4%, p<0.01). At 12 months, mortality was numerically higher for TB PCI (4.1% vs. 2.0%m p=0.052) and MACE rates were higher (13.2% vs. 5.2%, p<0.001). At 3 years, both all cause death (10.1% vs. 4.9%, p=0.002), as well as rates of MACE (27.2% vs. 11.6%, p<0.001) were higher for TB PCI (Figure 1). After performing regression analysis, TB remained an independent predictor for poor outcomes (OR- 3.93 at 12 months, CI 1.45–10.66, p=0.007, OR-3.26 at 3 years, CI 1.47–7.25, p=0.004 for MACE).
Conclusions
TB lesions, according to the Medina classification, portend worse prognosis for patients undergoing bifurcation PCI. This may guide prognostication and decision making in treatment.