Ten-year outcomes after percutaneous coronary intervention with drug-eluting stents for bifurcation lesions: insights from the DECADE cooperation

Patients treated with percutaneous coronary intervention (PCI) for bifurcation lesions have an increased risk of recurrent cardiac events. However, there are limited data on long-term outcomes after PCI with drug-eluting stents (DES) for bifurcation lesions. We sought to compare the long-term outcomes after DES PCI for bifurcation and non-bifurcation lesions among patients included in the Adverse Events and Coronary Artery Disease Progression (DECADE) cooperation, a pooled analysis of individual patient data from randomized controlled trials on DES platforms with a follow-up of 10 years. In the current analysis, patients undergoing PCI with DES were grouped according to whether the treated lesion was classified as a bifurcation or not. The main outcomes were cardiovascular death, myocardial infarction (MI) and target lesion revascularization (TLR) through to 10 years after PCI. Among the total of 6,617 patients included in this study, 1,580 patients underwent PCI of at least one bifurcation lesion and 5,037 patients underwent PCI of non-bifurcation lesions. Through to 10-year follow-up, cardiovascular death (adjusted hazard ratio [HRadj], 1.08 [95% CI, 1.03–1.14]) and TLR (HRadj, 1.50 [95% CI, 1.46–1.53]) occurred significantly more often after bifurcation PCI than after non-bifurcation PCI. Patients receiving a bifurcation PCI had a higher risk of MI at 10 years (HRadj, 1.42 [95% CI, 1.12–1.80]), with the highest risk within 30 days after PCI (HRadj, 2.14 [95% CI, 1.90–2.42]). In conclusion, patients who receive a PCI with a DES for a bifurcation lesion are at an increased risk of cardiovascular death, MI and TLR at 10-year follow-up. 10-year cardiovascular death risk is significantly higher after bifurcation PCI. Early MI rates are higher after bifurcation PCI, long-term MI rates are comparable. Rates of repeat revascularization are significantly higher after bifurcation PCI.