The Importance of Utilizing the Movahed Coronary Bifurcation Classification for Bifurcation Research
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I read the paper “One- Versus Two-Stent Stenting Strategies in Coronary Bifurcation Lesions” by Chan et al with great interest. The authors studied 1- vs 2-stent techniques in coronary bifurcation lesions.1 The authors defined bifurcation lesions as coronary artery stenoses adjacent to and/or involving the origin of a significant side branch. This is a description of true bifurcation lesions. In the Methods section, they mentioned that they used the Medina classification for all bifurcation lesions studied.
However, the authors do not mention any use of the Medina classification in their reported results or discussion. Why do the authors mention using the Medina classification in their Methods section but never use it when describing baseline characteristics of the lesions or performing any outcome data based on the Medina classification? The reason is obvious: The Medina classification, when studying true bifurcation lesions, is not only useless but confusing, as it separates true bifurcation lesions into 3 unnecessary subgroups (1.1.1; 1.0.1; 0.1.1) without any clinical relevance to outcomes. Furthermore, the Medina classification does not include other important features of a given bifurcation lesion, such as bifurcation angle, calcification, etc. Therefore, it is understandable that the authors could not perform a meaningful subgroup outcome analysis based on the Medina classification.
Instead of the Medina classification, the authors should have utilized the Movahed classification,2-5 which summarizes all true bifurcation lesions into one simple category called B2 lesions (B for bifurcation, 2 meaning both branches have significant disease at the bifurcation site). Furthermore, the Movahed classification has limitless suffixes that can be added to B2 to capture important features of a given bifurcation lesion, such as bifurcation angle, calcification, length of lesions, etc. Using the appropriate Movahed classification can enable researchers studying bifurcation lesions to perform meaningful subgroup analysis of high-risk features of a given bifurcation lesion, which is impossible when using the Medina classification.
Affiliations and Disclosures
Mohammad Reza Movahed, MD
From the University of Arizona Sarver Heart Center, Tucson, Arizona; and the University of Arizona College of Medicine, Phoenix, Arizona.
Disclosures: The author reports no financial relationships or conflicts of interest regarding the content herein.
Address for correspondence: Mohammad Reza Movahed, MD, PhD, FACP, FACC, FSCAI, University of Arizona Sarver Heart Center, 1501 North Campbell Avenue, Tucson, AZ 85724, USA. Email: Rmova@aol.com; Instagram: @m.reza.movahed
References
- Chan Z, Alexandrou M, Strepkos D, et al. One- versus two-stent stenting strategies in coronary bifurcation lesions. J Invasive Cardiol. 2025. doi:10.25270/jic/25.00096
- Movahed MR, Stinis CT. A new proposed simplified classification of coronary artery bifurcation lesions and bifurcation interventional techniques. J Invasive Cardiol. 2006;18(5):199-204.
- Movahed MR. Studies involving coronary bifurcation interventions should utilize the most comprehensive and technically relevant Movahed coronary bifurcation classification for better communication and accuracy. Am J Cardiol. 2010;105(8):1204-1205. doi:10.1016/j.amjcard.2009.12.030
- Movahed MR. The Movahed Coronary Bifurcation Lesion Classification introduces limitless optional suffixes that can easily be used for clinical use or coding purposes. Anatol J Cardiol. 2023;27(5):295-296. doi:10.14744/AnatolJCardiol.2023.3182
- Movahed MR. The shortcomings of the Medina compared to the Movahed coronary bifurcation classification. Future Cardiol. 2025;21(1):31-37. doi:10.1080/14796678.2024.2444156.
