Long term outcomes of left main stem trifurcation PCI compared to left main stem bifurcation anatomy
H Khan, S Sahibzada, M Omari, O Abukhalaf, M Farag, M EgredAbstract
Introduction
PCI has been established as a suitable treatment approach for LMS disease. There is a lack of data regarding the safety and efficacy of PCI in LMS trifurcation lesions.
Purpose
We assessed the long-term outcomes of patients with LMS trifurcation PCI compared to bifurcation PCI.
Methods
Retrospective analysis of all patients treated with PCI for LMS disease from January 2012 to March 2023. The primary outcome was all-cause mortality, secondary outcomes were target vessel failure, MI and angina.
Results
A total of 543 patients with LMS trifurcation lesions were matched with 418 patients with LMS bifurcation lesions. The median age was 71 (63-78) years in the trifurcation group and 70 (62-77) years in the bifurcation group. The primary outcome of all-cause mortality at median follow-up of 5.8 (3.5-8.9) years was significantly greater in the trifurcation group compared to the bifurcation group (40.7% vs 34%, p=0.027). Cox regression analysis demonstrated that trifurcations are associated with increased mortality (HR 1.267, 1.026 to 1.565). There were more perforations in the bifurcation group compared to the trifurcation group (2.4% vs 0.6%, p=0.014).
Conclusion
PCI in LMS trifurcation lesions is associated with higher longer-term mortality compared to LMS bifurcation lesions.Kaplan Meier Graph of all-cause mortalityFor image description, please refer to the figure legend and surrounding text.