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Clinical impact of complex percutaneous coronary intervention in patients with coronary artery disease
Hirohisa Endo1, Tomotaka Dohi2, Katsumi Miyauchi1
1Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan.
Insights
Complex percutaneous coronary intervention (C-PCI) involves intricate procedures but does not worsen mid-term clinical outcomes. Patients undergoing C-PCI experienced similar rates of death and major adverse cardiac events compared to non-complex PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Percutaneous coronary intervention (PCI) is a key revascularization technique.
- Complex PCI (C-PCI) requires advanced skills for challenging coronary anatomies.
- The clinical impact of C-PCI on patient outcomes remains incompletely understood.
Purpose of the Study:
- To investigate the association between C-PCI and mid-term clinical outcomes.
- To compare hard clinical endpoints in patients undergoing C-PCI versus non-complex PCI.
- To evaluate the prognostic significance of complex PCI procedures.
Main Methods:
- A cohort of 1062 patients undergoing PCI with newer-generation drug-eluting stents was analyzed.
- Patients were stratified into C-PCI (n=358) and non-complex PCI (non-C-PCI, n=704) groups.
- C-PCI was defined by specific procedural criteria including multiple vessels/lesions, stent length, chronic total occlusion, unprotected left main, or rotational atherectomy.
Main Results:
- The C-PCI group exhibited a significantly higher baseline SYNTAX score, indicating greater anatomical complexity.
- Kaplan-Meier analysis revealed no significant differences in cumulative incidences of all-cause death (p=0.12) or major adverse cardiac and cerebrovascular events (MACCE) (p=0.64) between groups.
- Multivariable Cox analysis confirmed that C-PCI did not adversely affect mid-term clinical outcomes.
Conclusions:
- Complex PCI procedures, despite anatomical challenges, are associated with comparable mid-term clinical outcomes to non-complex PCI.
- The technical complexity of C-PCI does not appear to translate into worse hard clinical endpoints.
- These findings support the safety and efficacy of C-PCI in managing patients with complex coronary artery disease.
Abstract:
For the revascularization of patients with clinical and anatomical complexities, several technical skills are often required. However, the prognostic effect of complex percutaneous coronary intervention (C-PCI) on the clinical outcomes is not well known. The aim of this study was to investigate the relationship between the C-PCI and mid-term clinical outcomes. We assessed 1062 patients who underwent PCI with newer-generation drug-eluting stent and stratified the patients according to whether they had complex PCI (C-PCI, n = 358) or non-complex PCI (non-C-PCI, n = 704). C-PCI was defined as a procedure with at least 1 of the following features: 3 vessels treated, ≥ 3 stents per vessel implanted, ≥ 3 lesions treated, use of a 2-stent technique, the total stent length per vessel > 60 mm, chronic total occlusion, unprotected left main coronary artery stenting, and rotational atherectomy use. All-cause death and major adverse cardiac and cerebrovascular events (MACCE; cardiovascular death, non-fatal myocardial infarction, and non-fatal ischemic stroke) were evaluated. The median follow-up period was 1.9 (0.8-3.0) years. The baseline SYNTAX score was significantly higher in the C-PCI group than in the non-C-PCI group [20 (14-27) vs. 10 (6-17), p < 0.001]. Kaplan-Meier analysis showed that the cumulative incidences of all-cause death (log-rank p = 0.12) and MACCE (log-rank p = 0.64) did not differ between the two groups. On multivariable Cox analysis, C-PCI did not adversely affect the clinical outcomes. Despite a high rate of anatomically complex coronary lesions, the patients who underwent C-PCI had comparable "hard" clinical outcomes with those of non-C-PCI.
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