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Published on: January 28, 2020
Ten-year clinical outcomes in patients with intermediate coronary stenosis according to the combined culprit lesion
Yong Kyun Kim1, Chae Won Jang1, Soon Ho Kwon1
1Division of Cardiology, Department of Internal Medicine, Konyang University Hospital, Daejeon, South Korea.
Insights
Intermediate lesions (IL) with a combined culprit lesion (CCL) have worse long-term outcomes. However, IL without CCL show better 10-year clinical outcomes than stented lesions, suggesting safe follow-up is possible.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Assessing long-term clinical outcomes of intermediate lesions (IL) is crucial.
- The impact of a combined culprit lesion (CCL) on IL outcomes requires further investigation.
Purpose of the Study:
- To evaluate the long-term clinical outcomes of intermediate lesions (IL).
- To determine if the presence of a combined culprit lesion (CCL) affects these outcomes.
Main Methods:
- Retrospective review of angiographic findings (n=1096) and medical charts.
- Patients with IL were stratified into two groups: IL without CCL (n=383) and IL with CCL (n=211).
Main Results:
- The IL with CCL group exhibited significantly higher rates of major adverse cardiovascular events (MACE), including death, myocardial infarction, stroke, and revascularization (RVSC), compared to the IL without CCL group.
- Predictors of MACE included CCL presence, IL stenosis, hypertension, prior PCI, blood glucose, and ejection fraction.
- IL-related RVSC was higher in the IL with CCL group, with predictors being IL stenosis and location in the right coronary artery.
Conclusions:
- Intermediate lesions (IL), particularly those without a CCL, demonstrate favorable 10-year clinical outcomes, surpassing those of stented lesions.
- IL can be safely managed with follow-up in settings lacking functional assessment capabilities.
Background:
We assessed the long-term clinical outcomes of an intermediate lesion (IL) according to the presence of a combined culprit lesion (CCL).
Hypothesis:
Long-term clinical outcomes of IL may be affected by the presence of a CCL.
Methods:
Angiographic findings (n = 1096) and medical chart were reviewed. Patients with IL were divided into two groups: IL without CCL group (n = 383, 64.5%) and IL with CCL group (n = 211, 35.5%).
Results:
The major adverse cardiovascular events (MACE) in the IL with CCL group were significantly higher than those in the IL without CCL group (death: 12.3% vs. 7.0%, myocardial infarction: 3.3%vs. 0.5%, stroke: 6.6% vs. 2.6%, and revascularization [RVSC]: 25.1% vs. 7.6%) during a mean follow up period of 118.4 ± 5.5 months. IL related RVSC rate in the IL with CCL group was higher than that in the IL without CCL group (5.7% vs. 2.1%, p = 0.020). RVSC rate related to IL in total subjects was lower than that related to stented lesion (3.4% vs. 6.4%). The important predictors of total MACE in total subjects were the presence of CCL, IL percent diameter stenosis, hypertension, history of percutaneous coronary intervention, blood glucose and ejection fraction. The predictors of IL related RVSC were IL percent diameter stenosis and IL located in the right coronary artery.
Conclusion:
10-year clinical outcomes of an IL (especially IL without CCL) were better than those of stented lesions. This study suggests that the IL can be safely followed up in sites that do not have ability to assess functional study.
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