Both mini-crush and provisional stenting strategies were associated with similar long-term clinical outcomes, and after adjusting for patient and lesion complexity, the stenting technique did not predict long-term prognosis, suggesting that anatomical and clinical factors may outweigh procedural strategy in bifurcation PCI.
Key Findings
Results
Event-free survival did not differ significantly between mini-crush and provisional stenting techniques over a median follow-up exceeding seven years.
157 total patients were included: 92 treated with provisional stenting and 65 with mini-crush strategy.
The primary endpoint was a composite of all-cause mortality and target lesion revascularisation (TLR).
Time-to-event analysis was performed using the Kaplan-Meier method and compared using the log-rank test.
Log-rank p = 0.738, indicating no statistically significant difference between groups.
Median follow-up exceeded seven years.
Results
Stenting technique was not independently associated with the composite endpoint of all-cause mortality and TLR in multivariable analysis.
Multivariable Cox proportional hazards regression was performed adjusting for age, prior PCI, multivessel disease, and lesion complexity.
Adjusted hazard ratio for stenting technique: HR 1.05, 95% CI 0.49–2.27; p = 0.90.
This indicates no independent predictive value of procedural strategy on long-term outcomes after covariate adjustment.
Results
In the prespecified Medina 1.1.1 subgroup (true bifurcation lesions with all three segments involved), long-term mortality and TLR rates were comparable across strategies.
A prespecified subgroup analysis was conducted specifically for patients with Medina 1.1.1 classified lesions.
Only true bifurcation lesions classified as Medina 1.1.1, 1.0.1, and 0.1.1 were included in the overall study.
Results in the Medina 1.1.1 subgroup were consistent with the overall cohort findings, showing no significant difference between strategies.
Discussion
Anatomical and clinical factors, rather than procedural technique, appear to be the primary drivers of long-term prognosis in bifurcation PCI.
Covariates adjusted for in multivariable analysis included age, prior PCI, multivessel disease, and lesion complexity.
After adjustment, stenting technique did not predict long-term prognosis (adjusted HR 1.05, 95% CI 0.49–2.27; p = 0.90).
Authors concluded that 'anatomical and clinical factors may outweigh procedural strategy in bifurcation PCI.'
This finding was consistent across both the overall cohort and the Medina 1.1.1 subgroup.
Methods
The study enrolled consecutive real-world patients undergoing bifurcation PCI, classified using the Medina classification system.
Study design was a real-world cohort study of consecutive patients.
Patients were treated with either provisional stenting or a planned mini-crush strategy.
True bifurcation lesions were classified according to the Medina classification; only Medina 1.1.1, 1.0.1, and 0.1.1 were included.
Total sample: 157 patients (92 provisional, 65 mini-crush).
What This Means
This research examined two different techniques for treating coronary bifurcation lesions — blockages that occur at the branching points of heart arteries — called 'mini-crush' and 'provisional stenting.' The study followed 157 real-world patients for a median of more than seven years to see whether one technique led to better long-term outcomes, specifically looking at death from any cause and the need for repeat procedures on the treated artery.
The study found no meaningful difference between the two techniques in long-term outcomes. When statistical analysis accounted for factors like patient age, history of prior heart procedures, presence of disease in multiple arteries, and lesion complexity, the choice of stenting technique had no significant effect on prognosis. This was true both for the overall group and for a specific subgroup of patients with the most complex type of bifurcation lesion (Medina 1.1.1). The adjusted hazard ratio was 1.05, meaning essentially identical risk in both groups.
This research suggests that for patients with coronary bifurcation lesions, the specific stenting technique used may matter less than the patient's underlying health factors and the complexity of their arterial disease. Rather than the procedural approach being the dominant factor in long-term outcomes, characteristics like age, the extent of coronary artery disease, and lesion anatomy appear to play a larger role. These findings add to an ongoing debate in cardiology about the best approach to bifurcation lesions, though the relatively small sample size and observational design mean results should be interpreted with caution.
Turna F, Yıldız M, Eynel E, Kocayigit &, Kocayigit H, Enhos A. (2026). Mini-crush versus provisional stenting in coronary bifurcation lesions: long-term results from a real-world cohort.. Cardiovascular journal of Africa. https://doi.org/10.5830/CVJA-2026-025