Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 21 4 2026 07 19 263 273 Akash Karwa Assistant Professor,U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC) Jayal Shah Professor, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC) Gourav Behra Assistant Professor, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC) Riyaz Charaniya Professor, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC) Krutika Patel Research Associate, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC) Kishan Hibare Assistant Professor,U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC) Sagar Vejani Assistant Professor, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC) Megh Shah DM Resident, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC) 2026 06 08 2026 07 19 Background: Coronary bifurcation lesions pose substantial challenges in percutaneous coronary intervention (PCI). This study aimed to assess the clinical and angiographic characteristics of patients undergoing PCI for bifurcation lesions in a South Asian population and to evaluate short-term outcomes. Methods: This prospective observational study was performed from June 2022 through September 2023 at a tertiary cardiac care center in individuals undergoing PCI for coronary bifurcation lesions. Results: A total of 259 participants were enrolled, with a mean (SD) age of 57.4 (10.9) years; 78.8% were male.The Medina classification indicated that the most common bifurcation lesion was left main–left anterior descending (LM–LAD) (43.2%). A total of 206 participants had LM bifurcation lesions, whereas 53 had non-LM lesions, with the LAD being the most frequently involved culprit vessel (94.2%). Ostial lesions were present in 68.3% of cases, and calcification was significantly more common in LM lesions (14.6%) than in non-LM lesions (1.9%; P=.01). Provisional stenting was the most common technique (62.6%), with double kiss crush used more frequently in LM bifurcation lesions (20.4% vs 3.8%; P < .001). Major adverse cardiovascular events (MACE) occurred in 38 participants (14.7%); they included 18 cardiac deaths (6.9%) and 13 cases of target vessel failure (TVF) (5.0%). No significant differences in MACE (P=.23) or death (P=.10) were observed between bifurcation lesion types or stenting strategies. Intravascular ultrasonography (IVUS) guidance was utlized in 70.3% of participants and was potentially associated with improved outcomes. Kaplan–Meier analysis revealed that severe left ventricular dysfunction was associated with a nearly 3-fold greater risk of death (hazard ratio [HR], 2.96; 95% CI, 0.98 to 8.96) and was the only independent predictor of all-cause mortality (HR, 3.23; 95% CI, 1.14 to 9.14; P=.027). Conclusion: Procedural complexity and lesion-related factors were not significantly associated with short-term mortality. These findings emphasize the importance of addressing myocardial dysfunction in risk stratification and management to improve outcomes in this high-risk population. https://rhythm.tums.ac.ir/index.php/jthc/article/view/2489 https://rhythm.tums.ac.ir/index.php/jthc/article/download/2489/1286