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Background Bifurcation coronary artery disease (CAD) represents 15-20% in PCI patients, however, limited data concerning the short and long term clinical outcome in AMI. Methods A total of 1402 patients underwent bifurcation lesions PCI were enrolled. Patients were divided into two groups: 1) chronic stable angina group (CSA, N = 954) and 2) acute myocardial infarction group (AMI, N = 448) (241 NSTEMI and 207 STEMI). Major adverse cardiac events (MACE), the composite of death, myocardial infarction (MI), stroke and revascularization and stent thrombosis were compared between the two groups at up to 5 years. Results At 30 days follow up, the AMI group had significantly higher incidence of total death (HR: 5.901, 95% CI : 1.879 to 18.532; p = 0.002), cardiac death (HR: 6.438, 95% CI 1.743 to 23.781; p = 0.005), MI (HR: 4.736 , 95% CI :1.646 to 13.632; p = 0.004), TLR (HR: 4.300 , 95% CI :1.295 to 14.279; p = 0.017), Stroke (HR: 5.901 , 95% CI :1.879 to 18.532; p = 0.002) and MACE (HR: 4.318, 95% CI : 1.940 to 9.611; p = 0.000) than the CSA group moreover, at 5 years follow up the AMI group had significantly higher incidence of MI , TLR , Stent Thrombosis and MACE than the CSA group.Using Multivariate logistic regression, and after adjusting for potential confounding factors, the AMI patients had higher incidence of total MACE at 30 days (HR: 3.668, 95% CI 1.572 to 8.558 ; p = 0.003) and at 5 years MACE (HR: 1.693, 95% CI 1.206 to 2.377 ; p = 0.002) Conclusion In this study, bifurcation lesion PCI in AMI setting was associated with a higher incidence of adverse clinical outcomes at 30 days and up to 5 years. Clinical Outcomes at 5 Years The incidence of Event (%) at 5 years Outcomes CSA (n = 954) AMI(n = 448) Log Rank Hazard ratio (95% Confidence interval ) P value Total death 21 (2.2) 14 (3.1) 0.285 1.443 (0.734-2838) 0.288 Cardiac death 10 (1.0) 10 (2.2) 0.078 2.160 (0.899-5.190) 0.085 Myocardial infarction 22 (2.3) 23 (5.1) 0.004 2.302 (1.283-4.130) 0.005 Revascularization 65 (6.8) 50 (11.2) 0.003 1.749 (1.210-2.529) 0.003 Target lesion 36 (3.7) 45 (6.4) 0.000 2.854 (1.831-4.448) 0.000 Target vessel 42 (4.4) 47 (10.5) 0.000 2.548 (1.680-3.863) 0.000 Non-target vessel 26 (2.7) 8 (1.8) 0.320 0.671 (0.304-1.482) 0.324 Stroke 131 (13.7) 66 (14.7) 0.555 1.093 (0.813-1.469) 0.556 Stent thrombosis 8 (0.8) 11 (2.5) 0.013 2.997 (1.205-7.451) 0.018 Total MACE 87 (9.1) 60 (13.4) 0.006 1.579 (1.135-2.196) 0.007

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