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Published on: February 28, 2012
Complex versus non-complex percutaneous coronary intervention in patients with atrial fibrillation: a real-world
Yimeng Wang1, Han Zhang1, Jiang-Shan Tan1
1Emergency and Intensive Care Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing, 100037, China.
Insights
Complex percutaneous coronary intervention (PCI) in patients with atrial fibrillation (AF) increases risks for myocardial infarction and revascularization. However, complex PCI did not significantly raise risks for major bleeding, death, or stroke/TIA in this AF population.
Area of Science:
- Cardiology
- Interventional Cardiology
- Atrial Fibrillation Management
Background:
- Patients with atrial fibrillation (AF) frequently undergo percutaneous coronary intervention (PCI).
- Increasing complexity of PCI procedures necessitates understanding clinical outcomes in AF patients.
- Limited data exists on outcomes following complex PCI in the AF population.
Purpose of the Study:
- To investigate the clinical outcomes of patients with atrial fibrillation undergoing complex PCI.
- To identify specific adverse events associated with complex PCI in AF patients.
Main Methods:
- Prospective, observational study design.
- Complex PCI defined by specific criteria (≥3 vessels, ≥3 stents, ≥3 lesions, or >60 mm total stented length).
- Primary outcome: Major Adverse Cardiovascular Event (MACE); Secondary outcome: Net Adverse Clinical Events (NACE).
Main Results:
- 1132 AF patients enrolled; 320 (28.2%) underwent complex PCI.
- Median follow-up of 1045 days.
- Complex PCI was independently associated with higher rates of spontaneous myocardial infarction (MI) and ischemia-driven revascularization.
- No significant differences in MACE or NACE between complex and non-complex PCI groups were observed initially, but adjusted analysis revealed increased MI and revascularization risks.
Conclusions:
- PCI complexity is an independent risk factor for adverse outcomes in AF patients.
- Specifically, myocardial infarction and revascularization events are more likely following complex PCI.
- Complex PCI was not associated with increased risk of major bleeding, all-cause mortality, or stroke/TIA.
Background:
Patients with atrial fibrillation (AF) often underwent percutaneous coronary intervention (PCI), and the complexity of PCI has risen in recent years. However, there is limited data available on clinical outcomes in patients with AF who underwent complex PCI.
Methods:
This was a prospective, observational study. Complex PCI was defined as PCI performed to ≥ 3 separate major coronary vessels; ≥3 stents implanted; ≥3 lesions treated; or total stented length > 60 mm. The primary outcome was defined as major adverse cardiovascular event (MACE) including all-cause death, spontaneous myocardial infarction (MI), stroke/ transient ischemic attack (TIA), systemic embolism or ischemia-driven revascularization. The secondary outcome was defined as net adverse clinical events (NACE), which included major adverse cardiovascular events (MACE) and major bleeding.
Results:
A total of 1132 patients who underwent PCI with AF were enrolled consecutively. The mean age was 67 ± 9, and 75.1% were male. 320 participants (28.2%) underwent complex PCI. During a median follow-up of 1045 days (interquartile range: 666-1327), the primary outcome occurred in 52 out of 320 patients (16.2%), while the secondary outcome was observed in 55 out of 320 patients (17.2%) in the complex PCI group. MACE showed no differences between groups (hazard ratio [HR], 1.30; 95% confidence interval [CI], 0.93-1.82), nor did NACE (HR:1.34, 95%CI: 0.97-1.85). Patients with complex PCI still had a higher likelihood of experiencing spontaneous MI (HR, 2.17, 95%CI, 1.00-4.70) and ischemic driven revascularization (HR, 1.86, 95%CI, 1.01-3.45) after adjusted for confounders.
Conclusion:
The complexity of PCI was an independent risk factor for adverse clinical outcomes, particularly for myocardial infarction and revascularization events in patients with atrial fibrillation. However, it was not associated with major bleeding, all-cause mortality, or stroke/TIA.
Clinical Trial Number:
Not applicable.
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