Percutaneous coronary interventions for aneurysmatic right coronary artery in acute coronary syndrome: RIGHTMARE
Giulio Piedimonte1, Enrico Cerrato1, Cristina Rolfo1
1Division of Cardiology, Interventional Unit - Infermi Rivoli Hospital, Rivoli (Turin), Italy and San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy.
Insights
Immediate or staged percutaneous coronary intervention (PCI) for aneurysmatic right coronary artery (ARCA) during acute coronary syndrome (ACS) yield similar outcomes. However, staged PCI increases bleeding risk and hospital stay compared to immediate PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Optimal percutaneous coronary intervention (PCI) strategy for aneurysmatic right coronary artery (ARCA) in acute settings is unknown.
- This study addresses the uncertainty surrounding PCI approaches for ARCA culprit lesions during acute coronary syndrome (ACS).
Purpose of the Study:
- To compare in-hospital and long-term outcomes of immediate versus staged PCI strategies for ARCA in ACS patients.
- Evaluate the efficacy and safety of different PCI timing approaches for ARCA.
Main Methods:
- Retrospective analysis of 85 ACS patients undergoing ARCA PCI across 18 European centers.
- Data collected on PCI strategy (immediate vs. staged), pharmacologic approach, and procedural success (technical success without in-hospital MACE).
Main Results:
- No significant difference in procedural success between immediate (50.9%) and staged (43.3%) PCI groups.
- Staged PCI group showed higher rates of major bleeding (BARC types 3 & 5) and longer hospital stays.
- Similar rates of target lesion failure (24.1%) observed between groups at 3-year follow-up.
Conclusions:
- Immediate and staged PCI strategies for ARCA in ACS patients have comparable in-hospital and long-term results.
- Staged PCI is linked to increased major bleeding risk and prolonged hospitalization compared to immediate PCI.
- No independent predictors for procedural success were identified in either strategy.
Background:
The optimal strategy during percutaneous coronary intervention (PCI) of aneurysmatic right coronary artery (ARCA) remains uncertain and has never been tested in the acute setting.
Objectives:
To compare the in-hospital and long-term outcomes of immediate and staged PCI strategies for ARCA as culprit lesions during acute coronary syndrome (ACS).
Methods:
Among 102.376 PCIs performed in 18 European centers, a total of 85 patients presenting with acute coronary syndrome undergoing ARCA PCI were finally included in the analysis. PCI strategy (stenting performed during the immediate vs staged procedure) and pharmacological approach adopted were collected. The primary outcome was procedural success (technical success without in-hospital MACE).
Results:
The primary outcome occurred in 48.2 % of cases, with no significant differences observed between the immediate and staged PCI groups (50.9 % vs 43.3 %, p = 0.504). Patients in the staged-PCI group had a significantly higher rate of intravenous anticoagulant use (83.3 % vs 48.1 %, p = 0.002), BARC type 3 and 5 bleedings (12.9 % vs 1.9 %, p = 0.037), and longer in-hospital stay (7.40 ± 5.11 vs 9.5 ± 5.25 days, p = 0.049). After multivariate analysis, no independent predictors for procedural success were found in either group. Target lesion failure occurred in 24.1 % of cases without differences between groups at a median follow-up of three years.
Conclusions:
Among patients undergoing ARCA PCI in the setting of ACS, immediate or staged PCI were associated with similar in-hospital and long-term outcomes. However, staged PCI was associated with a higher risk of major bleeding events and longer length of stay compared to immediate PCI strategy.
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