Related Experiment Video
Updated: Feb 19, 2026
Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
Prognostic Impact of Subsequent Acute Coronary Syndrome and Unplanned Revascularization on Long-Term Mortality After
Taku Inohara1,2, Shun Kohsaka3, Hiroaki Miyata4
1Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
Insights
Subsequent acute coronary syndromes (ACS) after percutaneous coronary intervention (PCI) increase mortality risk. However, unplanned revascularization or unstable angina alone did not significantly impact long-term survival in PCI patients.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Clinical Trials
Background:
- Composite endpoints are common in percutaneous coronary intervention (PCI) trials.
- The individual impact of PCI outcomes on long-term survival needs further clarification.
Purpose of the Study:
- To assess the association between post-PCI acute coronary syndromes (ACS) and unplanned revascularization with long-term survival.
- To differentiate the prognostic impact of individual components within composite endpoints.
Main Methods:
- Analysis of the KiCS-PCI registry (2009-2011) including 3348 patients undergoing PCI.
- Propensity-matched cohorts compared survival between patients with and without subsequent ACS or unplanned revascularization.
- Cox proportional hazard models evaluated 2-year all-cause mortality, with a separate analysis for unstable angina.
Main Results:
- A subsequent ACS event was associated with a significantly increased mortality risk (HR, 4.73; P=0.015).
- Unplanned revascularization did not show a statistically significant increase in mortality risk (HR, 2.97; P=0.19).
- Unstable angina events, a subset of ACS, were not significantly associated with increased mortality (HR, 1.39; P=0.54).
Conclusions:
- Subsequent ACS events post-PCI are linked to higher mortality.
- The prognostic significance of unplanned revascularization and unstable angina alone is less pronounced.
- Consideration of individual component implications is crucial for interpreting composite endpoints in PCI clinical trials.
Background:
Whereas composite end points are often used in clinical trials of percutaneous coronary interventions (PCI), the impact of individual components on subsequent survival is incompletely defined. We evaluated the association of subsequent acute coronary syndromes (ACS) and unplanned coronary revascularization post-PCI with long-term survival.
Methods And Results:
From 2009 to 2011, the KiCS-PCI (Keio interhospital Cardiovascular Studies) consecutively enrolled patients undergoing PCI in 14 Japanese teaching hospitals. We identified patients who experienced ACS or unplanned coronary revascularization following their index PCI and compared subsequent survival during the 2-year follow-up period using propensity-matched cohorts of patients who did and did not experience these events. Cox proportional hazard models were used to assess 2-year all-cause mortality. Because unstable angina is less severe than acute myocardial infarction, we also generated a separate propensity-matched cohort for UA post-PCI. Among 3348 PCI patients (mean age, 67.5±10.7 years; 79.7% male), 214 (6.4%) experienced a subsequent ACS (168 events [78.5%] were unstable angina), and 198 (5.9%) underwent unplanned revascularization. In the propensity-matched cohorts, patients with a subsequent ACS admission had an increased risk of mortality as compared with those without (hazard ratio, 4.73; 95% confidence interval=1.35-16.6; P=0.015), whereas those with an unplanned revascularization did not have significantly higher risk (hazard ratio, 2.97; 95% confidence interval=0.57-14.3; P=0.19). Among unstable angina events, no association with mortality was observed (hazard ratio, 1.39; 95% confidence interval=0.48-4.00; P=0.54).
Conclusions:
In the KiCS-PCI registry, the incidence of a subsequent ACS was associated with higher mortality, but this association was less apparent after unplanned coronary revascularization or unstable angina. The prognostic implications of different outcomes in a composite end point should be considered when interpreting the results of clinical trials in PCI.
More Related Videos
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
07:25Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations