Introduction: Bifurcation lesions present major percutaneous coronary interventional challenge. Data on outcomes in bifurcation lesion appears sparse and hence here we seek to evalute the procedural trends and outcomes in Percutaneous Coronary Intervention (PCI) on bifurcation lesions.
Methods: We queried Nationwide Inpatient Sample (NIS) from 2008 to 2014, a subset of Healthcare Cost and Utilization Project (HCUP) sponsored by the Agency for Healthcare Research and Quality (AHRQ) using ICD 9 diagnosis codes for PCI and bifurcation lesions (00.44). Cochran-Armitage test for trend was used to test the significance.
Results: Out of 3466788 patients (weighted) who underwent one or two vessel PCI, 91983(2.65%) had procedure on bifurcation lesions (mean age 64.35 years, 31.76% females). Overall, there was a decline in one/two vessel PCI from 600385 procedures in 2008 to 412395 in 2014(Relative decrease of 31.31%; p<0.0001). Of this, there were 2.52% procedures on bifurcation lesions in 2008 and 2.6% in 2014 thereby representing a slight increase of 3.17% (P=0.0026). In-hospital mortality and all complication rates increased during the study period (Figure 1). There was a relative decline of 28.68% in vascular complications (p<0.0001) and only a slight increase in cardiac complications from 6.33% in 2008 to 6.56% in 2014(relative increase of 3.63%, p<0.0001). However, there was a remarkable increase in non-cardiac/non-vascular complications rates most notably of respiratory complication rates (relative increase 177%, p<0.0001).
Conclusions: There seems to be a trend towards worsening mortality and overall complications rates after procedures on bifurcation lesions which seems to be largely driven by non-cardiac/non-vascular causes. While improvement in technical PCI expertise may continue to provide further improvement in outcomes but further research exploring non-cardiac non vascular complications is also warranted.