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Association of Residual Ischemic Disease With Clinical Outcomes After Percutaneous Coronary Intervention

Christopher P Kovach1, Annika Hebbe2, Thomas J Glorioso2

  • 1Division of Cardiology, Department of Medicine, University of Colorado, Aurora, Colorado, USA; Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA.

JACC. Cardiovascular Interventions
|December 21, 2022
PubMed

Insights

Residual ischemic disease after percutaneous coronary intervention (PCI) significantly increases the risk of major adverse cardiovascular events (MACE). Automatically computed anatomic complexity scores can assess this risk and improve interventional quality.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Health Services Research

Background:

  • Anatomical scoring systems are used to assess revascularization completeness but are difficult to apply to large datasets.
  • The U.S. Department of Veterans Affairs (VA) health care system provides a large real-world dataset for analysis.

Purpose of the Study:

  • To assess the prevalence of complete revascularization.
  • To evaluate the association between complete revascularization and longitudinal clinical outcomes.
  • To utilize an automatically computed anatomic complexity score for this assessment.

Main Methods:

  • A cohort of 57,476 veterans undergoing percutaneous coronary intervention (PCI) between 2007 and 2020 was identified.
  • The VA SYNTAX score was used to quantify ischemic disease burden before and after PCI.
  • The association between residual VA SYNTAX score and major adverse cardiovascular events (MACE) at long-term follow-up was analyzed.

Main Results:

  • Higher residual VA SYNTAX scores were associated with increased hazards of MACE and death at 3 years.
  • The hazard of MACE increased with residual disease, irrespective of baseline severity or presentation.
  • Complete revascularization (residual VA SYNTAX score = 0) was associated with better outcomes.

Conclusions:

  • Residual ischemic disease after PCI is strongly linked to long-term adverse clinical outcomes.
  • Automatically computed anatomic complexity scores can effectively assess longitudinal risk for residual ischemic disease.
  • These scores may be implemented to enhance the quality of interventional procedures.
Abstract

Keywords:
anatomical complexity scoremortalityoutcomespercutaneous coronary interventionqualityresidual ischemic disease

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