Impact of coronary lesion complexity in percutaneous coronary intervention: one-year outcomes from the large,
Mohamed O Mohamed1, Jawed Polad, David Hildick-Smith
1Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, Newcastle, United Kingdom.
Insights
Complex percutaneous coronary intervention (PCI) increases the one-year risk of mortality and complications. The number and type of complex features significantly impact patient outcomes after PCI.
Area of Science:
- Interventional Cardiology
- Cardiovascular Research
- Medical Device Technology
Background:
- Percutaneous coronary intervention (PCI) is a common treatment for coronary artery disease.
- Complex PCI involves challenging anatomical or procedural characteristics.
- Understanding outcomes in complex PCI is crucial for patient management.
Purpose of the Study:
- To determine the prevalence and clinical characteristics of patients undergoing complex PCI.
- To evaluate the one-year outcomes of complex PCI procedures.
- To analyze the impact of specific complex features on patient outcomes.
Main Methods:
- Prospective multicentre registry (e-Ultimaster).
- Post hoc subgroup analysis of 35,839 patients undergoing PCI.
- Stratification by procedure complexity and number/type of complex features.
Main Results:
- Complex PCI patients (27.3%) were older, more comorbid, and had higher one-year risk of target lesion failure (TLF).
- Increased hazard ratios observed for cardiac death, myocardial infarction, and revascularization in complex PCI.
- Higher number of complex features correlated with increased complication risk; most features increased complication hazard.
Conclusions:
- Complex PCI is associated with elevated one-year mortality and complication rates.
- The specific number and types of complex features influence long-term outcomes differently.
- Risk stratification based on complexity is essential for managing patients undergoing PCI.
Aims:
The present study sought to examine the prevalence, clinical characteristics and one-year outcomes of patients undergoing percutaneous coronary intervention (PCI) to complex lesions (multivessel PCI, ≥3 stents, ≥3 lesions, bifurcation with ≥2 stents, total stent length >60 mm or chronic total occlusion [CTO]) in a prospective multicentre registry.
Methods And Results:
Using the e-Ultimaster multicentre registry, a post hoc subgroup analysis was performed on 35,839 patients undergoing PCI, stratified by procedure complexity, and further by number and type of complex features. Overall, complex PCI patients (n=9,793, 27.3%) were older, more comorbid and were associated with an increased hazard ratio (HR) of the composite endpoint at one year (target lesion failure [TLF]: 1.41 [1.25; 1.59]), driven by an increased hazard of cardiac death (1.28 [1.05; 1.55]), target vessel myocardial infarction (1.48 [1.18; 1.86]) and clinically driven target lesion revascularisation. The hazard of complications increased with the rising number of complex features (3-6 vs 1-2 vs none) for all outcomes. All individual complex features were associated with an increased hazard of composite complications (except CTO) and definite/probable stent thrombosis.
Conclusions:
Overall, complex PCI is associated with an increased risk of mortality and complications at one year. The number and types of complex features have differing impacts on long-term outcomes.
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Acute Coronary Syndrome I: Introduction
01:27Coronary Artery Disease V: Interprofessional Care
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Coronary Artery Disease III: Clinical Manifestations