Comparison of Bifurcation and Trifurcation Anatomy in Distal Left Main Coronary Artery Stenting

Aim: Although there is a lot of data comparing bifurcation and non-bifurcation lesions in left main coronary artery (LMCA) percuteneous coronary intervention (PCI), the specific influence of trifurcation anatomy on procedural outcomes and long-term prognosis is poorly understood.Given the technical complexities and probable disparities in clinical outcomes, a thorough research of these anatomical subgroups is required.This study aimed to compare procedural and clinical outcomes between bifurcation and trifurcation LMCA lesions. Material and Methods: This retrospective study analyzed patients who underwent distal LMCA stenting between January 2019 and June 2024. Patients with stable coronary artery disease (CAD) without prior coronary artery bypass grafting (CABG) and who underwent intravascular ultrasound (IVUS)-guided stenting and who have high surgical risk, as assessed by a heart team, or patient preferencefor PCI were included.Those with acute coronary syndrome at presentation, prior CABG, or PCI performed without IVUS guidance were excluded.A total of 43 eligible patients were identified from institutional records.Data were collected retrospectively, including procedural details, clinical outcomes, and follow-up findings.Results: There were no significant differences in baseline characteristics, including biochemical parameters and comorbidities, between the two groups (p>0.05).Trifurcation lesions required significantly longer stents (p=0.008).Ischemic events were more common in the trifurcation group (33.3% vs. 4.5%, p=0.015), and major adverse cardiac event (MACE) rates were significantly higher in the trifurcation group compared to the bifurcation group (57.1% vs. 9.1%, p=0.001).Bleeding events and mortality rates did not significantly differ between the groups (p>0.05). Conclusion:Patients with LMCA trifurcation lesions undergoing PCI exhibit higher ischemic event rates and MACE compared to those with bifurcation lesions, despite IVUS guidance.Further prospective studies are warranted to optimize treatment strategies for this high-risk population.