Abstract 20549: Use of Advanced Interventional Tools for PCI on Bifurcation Lesions - A Review of Seven Year National Data

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Introduction: Bifurcation lesions are complex and can be very time-consuming, expensive to intervene, and carry a high risk of restenosis. Data on use of the advanced technology and techniques for PCI on these lesions appears sparse.

Methods: We queried Nationwide Inpatient Sample (NIS) from 2008 to 2014, a subset of Healthcare Cost and Utilization Project sponsored by the Agency for Healthcare Research and Quality using ICD9 diagnosis codes for PCI, bifurcation lesions (00.44), IVUS, OCT, FFR, Atherectomy, GPIIb/IIIa inhibitors, mechanical circulatory support, use of vasopressors, number of vessels treated and number of stents inserted. Categorical variables were compared using Chi-squared test.

Results: We analyzed 91983 procedures on bifurcation lesions and compared those with 3374805 one/two vessel PCI on non bifurcation lesions. There was a higher use of IVUS (9.17% vs 6.55%, p<0.0001), OCT (0.2 vs 0.12%, p<0.0001), FFR (2.17% vs 1.37%, p<0.0001), Atherectomy (2.01% vs 1.19%, p<0.0001) and mechanical circulatory support (3.72% vs 3.33%, p<0.0001) during PCI on bifurcation lesions (Figure 1). Similarly, GPIIb/IIIa inhibitors were used more commonly during PCI on bifurcation lesions (20.15% vs 16.65%, p<0.0001). There was no difference in use of vasopressors. More of bifurcation lesions had intervention on two vessels (45.17% vs 16.23%, p<0.0001).

Conclusions: Our study quantifies use of Cath lab tools associated with PCI on bifurcation lesions. Further research exploring impact of these tools on outcomes including mortality benefit and complication rates in bifurcation lesions is warranted.

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