Bifurcation percutaneous coronary intervention in octogenarians and nonagenarians: insights from the PROGRESS-BIFURCATION registry

The outcomes of bifurcation percutaneous coronary intervention (PCI) in octogenarians and nonagenarians have received limited study. We compared the procedural characteristics and outcomes of bifurcation PCIs among patients ≥80 vs <80-years-old in a multicenter registry. Of 1,253 patients who underwent 1,262 bifurcation PCIs between 2014 and 2024 at six centers, 194 (15%) were octogenarians or nonagenarians. Compared with younger patients, octo- and nonagenarians were more likely to have atrial fibrillation (30 vs. 12%, p < 0.001) and heart failure (39 vs. 19%, p < 0.001). They were more likely to have bifurcation lesions with higher angiographic complexity, including severe calcification (38 vs. 14%, p < 0.001), and left main coronary artery (30% vs. 0%, p < 0.001) and left anterior descending artery (80% vs. 70%, p < 0.001) stenoses. They had lower procedural success (87 vs. 92%, p = 0.026) and higher incidence of in-hospital major adverse cardiovascular events (MACE, 8.3% vs. 3.4%, p = 0.002) and death (3.1% vs. 1%, p = 0.035). During a median follow-up of 903 days, octo- and nonagenarians had higher follow-up MACE (47.3% vs. 28.1%, p < 0.001), mortality (38.4% vs. 10.9%, p < 0.001) and stroke (6.8% vs. 2.9%, p = 0.018) compared with younger patients. In multivariable analysis follow-up MACE was independently associated with age ≥80-years (hazard ratio 1.46, 95% confidence intervals 1.05-2.04, p=0.026). In conclusion, compared with younger patients, success rates were lower and the risk of complications was higher in octo- and nonagenarians undergoing bifurcation PCI.