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Published on: July 12, 2024
Percutaneous Coronary Intervention in Patients with Coronary Artery Ectasia: A Retrospective Single-center Study
Shoaib Subhan1, Muhammad Shehram1, Malik F Iftikhar2
1Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Islamabad, Pakistan.
Insights
Planned percutaneous coronary intervention (PCI) in patients with coronary ectasia shows better outcomes than ad-hoc PCI. This approach reduces mortality and major adverse cardiovascular events, highlighting its superiority for managing coronary ectasia.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Coronary ectasia presents unique challenges for percutaneous coronary intervention (PCI).
- The optimal timing for PCI in patients with coronary ectasia remains a subject of investigation.
- Understanding outcomes differences between ad-hoc and planned PCI is crucial for clinical decision-making.
Purpose of the Study:
- To compare the procedural outcomes and long-term results of ad-hoc versus planned PCI in patients diagnosed with coronary ectasia.
- To identify predictors of mortality in this patient cohort.
- To evaluate the impact of PCI strategy on major adverse cardiovascular events (MACE) and other clinical endpoints.
Main Methods:
- Retrospective analysis of 3,179 patients with coronary ectasia undergoing PCI.
- Comparison of baseline characteristics, technical success, stent deployment success, and MACE between ad-hoc and planned PCI groups.
- Logistic regression analysis to determine independent predictors of mortality.
Main Results:
- The ad-hoc PCI group had a higher prevalence of comorbidities and lower technical/stent deployment success rates.
- Planned PCI was associated with significantly lower rates of MACE, all-cause mortality, recurrent angina, and target lesion revascularization.
- Older age, male gender, hypertension, diabetes, smoking, multi-vessel disease, and coronary ectasia were identified as predictors of mortality.
Conclusions:
- Planned PCI offers superior procedural outcomes and reduced mortality and adverse events compared to ad-hoc PCI in patients with coronary ectasia.
- Coronary ectasia itself is an independent predictor of mortality.
- These findings support a preference for planned PCI strategies in managing coronary ectasia.
Objective:
This retrospective single-center study aimed to compare the outcomes of ad-hoc versus planned percutaneous coronary intervention (PCI) in patients with coronary ectasia. We investigated baseline characteristics, primary and secondary outcomes, and predictors of mortality in a cohort of patients who underwent PCI procedures.
Methods:
Data from 3,179 patients (ad-hoc PCI, n = 1,286; planned PCI, n = 1,893) with coronary ectasia were analyzed. Baseline characteristics, including age, gender, comorbidities, and lesion characteristics, were compared between the two groups. Primary outcomes included technical success and stent deployment success, while secondary outcomes encompassed major adverse cardiovascular events (MACE), all-cause mortality, recurrent angina, and target lesion revascularization. Logistic regression was utilized to identify predictors of mortality.
Results:
The ad-hoc PCI group exhibited a higher prevalence of comorbidities, including hypertension, diabetes mellitus, smoking history, and multi-vessel disease (all p < 0.05). While technical success and stent deployment success rates were lower in the ad-hoc PCI group (p < 0.05), patients undergoing planned PCI demonstrated significantly lower rates of MACE, all-cause mortality, recurrent angina, and target lesion revascularization (all p < 0.05). Logistic regression analysis identified older age, male gender, hypertension, diabetes mellitus, smoking history, and multi-vessel disease as independent predictors of mortality (all p < 0.05). Importantly, coronary ectasia emerged as an additional predictor of mortality (p = 0.002).
Conclusion:
Our study indicates that planned PCI is associated with improved procedural outcomes and lower rates of mortality and adverse events compared to ad-hoc PCI in patients with coronary ectasia.
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