Prognostic Significance of the Medina Classification in Bifurcation Lesion Percutaneous Coronary Intervention

Introduction: The Medina classification is the most widespread method to describe bifurcation lesions. Little is known regarding the prognostic significance of the classification following percutaneous coronary intervention (PCI).

Methods: The study included 505 consecutive patients from our prospective bifurcation registry. There were 407 patients (80.5%) with “true bifurcation” (TB) lesions (Medina class 1.0.1, 1.1.1, 0.1.1) and 98 (19.5%) in all other categories. We compared rates of death and major adverse cardiac events (MACE), which included cardiac death, myocardial infarction, or target vessel revascularization.

Results: Patient characteristics were similar between the two PCI groups, except for lower rates of previous bypass surgery (7.4% vs. 11.2%, p=0.005) and hyperlipidemia (72.2% vs. 81.0%, p<0.001) in TB group. TB lesions also had higher rates of calcified (35.8% vs. 28.1%, p=0.02) and ulcerated (9.9% vs. 1.4%, p<0.001) plaques. More were treated with 2 stents (44.3% vs. 15.4%, p<0.001) and final kissing balloon dilatation (74.2% vs. 59.2%, p<0.001). All cause death rates were higher for TB PCI (19.8% vs. 9.2% at 3 years, p<0.001), as were rates of MACE (at 3 years 35.9% vs. 16.2%, p<0.001). After performing regression analysis, TB remained an independent predictor for poor outcomes both at 12 months (OR-4.375, CI 1.4-15.50, p=0.010) and 3 years (OR-3.34, CI 1.52-7.37, p=0.003).

Conclusions: TB lesions, according to the Medina classification, portend worse prognosis for patients undergoing PCI. This may guide prognostication and decision making in treating bifurcation PCI.