New research reveals the development of a novel assessment tool that accurately predicts major adverse cardiovascular events (MACE) after a percutaneous coronary intervention (PCI) for true bifurcation lesions. The paper, published in the March 24 issue of JACC: Cardiovascular Interventions, concludes that the BifurcAID risk score may aid in risk stratification among these patients and guide patient-tailored treatment strategies. “PCI for true bifurcation lesions remains a significant challenge, with higher rates of adverse events compared to simpler coronary procedures," said lead investigator Shingo Minatoguchi, MD, from the Icahn School of Medicine at Mount Sinai, New York. “This system aligns with the current understanding of the complexities involved in bifurcation lesion management.” MACE predictors In an analysis of nearly 1,900 patients treated for bifurcation lesions between 2012 and 2019, the research team found that at 1-year post-PCI, MACE occurred in 185 patients (9.8%). Eleven predictors of MACE were identified, five of which were clinically-related (insulin-dependent diabetes mellitus, left ventricular ejection fraction ≤30%, non–ST-segment elevation myocardial infarction presentation, age >80 years, and non-white race/ethnicity). Additionally, six angiographic-related predictors were identified (left main or left circumflex-obtuse marginal coronary artery lesion, multivessel disease, side branch [SB] thrombus, SB moderate/severe calcium and SB lesion length >10 mm). The rate of MACE was 4.9% in low-risk patients with a risk score 0 to 6 (reference group), 12.9% in intermediate-risk patients with a score 7 to 9 (odds ratio [OR]: 2.63; 95% confidence interval [CI]: 1.74-3.98; P<0.001) and 25.4% in high-risk group with a score ≥10 (OR: 5.18; 95% CI: 3.56-7.53; P < 0.001). Yiannis S. Chatzizisis, MD, PhD, from the University of Miami, and Saurabhi Samant, MBBS, from the Albert Einstein School of Medicine in the Bronx, New York, stressed the importance of personalized approaches in PCI for bifurcation lesions in an accompanying editorial. Risk models “Despite advancements in drug-eluting-stent technologies and the adoption of intracoronary imaging, managing true coronary bifurcation lesions remains a procedural and prognostic challenge," the editorialists wrote. “It highlights the need for comprehensive risk models that integrate both lesion complexity and patient comorbidities to improve outcomes.” However, they pointed out that the BifurcAID score was developed based on a single-center, retrospective study, with the experts calling for external validation and the integration of procedural factors such as operator expertise and stent selection. Looking ahead, the editorial suggests artificial intelligence and computational simulations could further refine PCI strategies, marking a step toward truly personalized coronary interventions. Study methods A total of 1,896 consecutive patients undergoing PCI for true bifurcation lesions between 2012 and 2019 in our institution were included. A multivariate model identified factors associated with 1-year MACE, comprising all-cause death, myocardial infarction, and target vessel revascularization. Points were assigned to each risk factor proportional to their regression coefficients to create a cumulative risk score that was used to stratify patients into low-, intermediate- and high-risk cohorts. Sources: Minatoguchi S, Koshy AN, Vengrenyuk Y, et al. Development of a Novel BifurcAID Risk Score to Predict MACE Following Coronary True Bifurcation Intervention. JACC Cardiovasc. Interv. 2025;18:705–716. Chatzizisis YS, Samant S. Personalized Coronary Interventions. JACC Cardiovasc. Interv. 2025;18:717–719. Image Credit: Nadzeya – stock.adobe.com