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Published on: May 26, 2023
Outcomes in patients undergoing multivessel percutaneous coronary intervention using sirolimus-eluting stents: a
Florim Cuculi1, Adrian P Banning, Alexander Abizaid
1Oxford Heart Centre, Oxford, UK.
Insights
Multivessel percutaneous coronary intervention (PCI) showed excellent outcomes but had higher rates of periprocedural myocardial infarction and major adverse cardiac events (MACE) compared to single-vessel PCI in a large real-world study.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Research
Background:
- Percutaneous coronary intervention (PCI) for multiple coronary lesions offers economic and social benefits.
- Limited real-world data exists on the comprehensive outcomes of multivessel PCI.
- The e-SELECT registry provides a large dataset to evaluate these outcomes.
Purpose of the Study:
- To compare short- and long-term outcomes of single-vessel versus multivessel PCI.
- To analyze data from the e-SELECT registry, which includes patients treated with sirolimus-eluting stents (SES).
- To assess rates of myocardial infarction and major adverse cardiac events (MACE).
Main Methods:
- Retrospective analysis of the e-SELECT registry data.
- Inclusion of 15,147 patients undergoing either single-vessel or multivessel PCI.
- Comparison of outcomes including myocardial infarction and MACE between the two groups.
Main Results:
- Multivessel PCI patients were slightly older with higher diabetes prevalence.
- Higher rates of periprocedural myocardial infarction (1.9% vs 0.8%) in the multivessel PCI group.
- One-year MACE rates were significantly higher in the multivessel PCI group (6.1% vs 4.6%).
Conclusions:
- Both single- and multivessel PCI demonstrated excellent procedural and one-year outcomes.
- Multivessel PCI was associated with increased periprocedural myocardial infarction and MACE.
- Despite lower lesion complexity, multivessel PCI carries a higher risk in real-world practice.
Aims:
Performing percutaneous coronary intervention (PCI) to multiple coronary lesions during the same procedure has potential economic and social advantages. However comprehensive outcome data of real world practice in a large population is limited. We aimed to compare short- and long-term outcomes between patients with multivessel coronary artery disease who either underwent single- or multivessel PCI within the e-SELECT registry.
Methods And Results:
The e-SELECT registry combines data collected at 320 medical centres in 56 countries where patients received CYPHER Select® or CYPHER Select® Plus sirolimus-eluting stent (SES). Rates of myocardial infarction and major adverse cardiac event (MACE) (defined as any death, myocardial infarction or target lesion revascularisation) were compared between patients undergoing single-vessel versus multivessel PCI. A total of 15,147 patients who satisfied the inclusion criteria were included in the e-SELECT registry. Two thousand two hundred and seventy-eight (2,278) subjects (15%) underwent multivessel PCI and 12,869 (85%) had single-vessel PCI. The mean age was higher in the multivessel PCI group (63 vs. 62 years, p<0.001) and there was a higher prevalence of diabetes mellitus (32.4 vs. 30.0%, p=0.02). Lesions were more complex in the single-PCI group while pre- and post-dilatation were less common in the multivessel PCI group. Myocardial infarction within the first 30 days post PCI was more common in the multivessel PCI group (1.9 vs. 0.8%, p<0.001) and most of the infarctions were periprocedural (1.3 vs. 0.6%, p=0.001). Mortality and myocardial infarction at one-year were higher in the multivessel PCI group resulting in a significantly higher MACE (6.1 vs. 4.6%, p=0.005).
Conclusions:
Overall procedural and one year outcomes were excellent for both single- and multivessel procedures. However despite lower lesion complexity, performing multivessel PCI was associated with higher rates of periprocedural myocardial infarction and MACE when compared to single-vessel PCI in the e-SELECT registry.
