title: Impact of bifurcation target lesion on angiographic, electrocardiographic, and clinical outcomes of patients undergoing primary percutaneous coronary intervention (from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction [HORIZONS-AMI] trial).
abstract: OBJECTIVE
  Using the database from the large-scale, prospective, randomised HORIZONS-AMI trial, the authors sought to assess the impact of bifurcation target lesions (BTL) on angiographic, electrocardiographic, and clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI).
  
  
  RESULTS
  In HORIZONS-AMI, bifurcation lesions in which a provisional approach was planned were eligible for enrolment. By angiographic core laboratory assessment of 3,306 patients with STEMI undergoing primary PCI, 333 patients (10%) had ≥1 BTL, and 2,973 patients had no BTL. There were no significant differences in baseline characteristics between the groups, except for lower left ventricular ejection fraction and more frequent left anterior descending infarct artery in the BTL group. BTLs required longer procedural and fluoroscopy times and higher contrast loads, but rates of TIMI 3 flow post PCI were similar in both groups (with vs. without BTL 99% vs. 87%, p=0.25). ST-segment resolution ≥70% by core laboratory analysis was similar in both groups (48% vs. 50%, p=0.47). Importantly, there was no difference between groups in the rate of death (6.1% vs. 6.7%, p=0.72), definite or probable stent thrombosis (4.2% vs. 5.2%, p=0.42), and ischaemic target vessel revascularisation (14.3% vs. 14.0%, p=0.86) during three-year follow-up.
  
  
  CONCLUSIONS
  Although the PCI procedure involving BTL was more complex, the acute results and late outcomes in patients with BTLs were comparable to those in patients without BTLs.
authors.affiliation: Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Dudek
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Artur
authors.initials: A
authors.lastname: Dziewierz
authors.forename: Sorin J
authors.initials: SJ
authors.lastname: Brener
authors.forename: Tomasz
authors.initials: T
authors.lastname: Rakowski
authors.forename: Michal
authors.initials: M
authors.lastname: Brzezinski
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Brodie
authors.forename: Ke
authors.initials: K
authors.lastname: Xu
authors.forename: Martin
authors.initials: M
authors.lastname: Fahy
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Lansky
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Zmudka
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D006801:Humans; D009203:Myocardial Infarction; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D015607:Stents; D016896:Treatment Outcome