Philippe Généreux1, Gennaro Giustino2, Björn Redfors3, Tullio Palmerini4, Bernhard Witzenbichler5, Giora Weisz6, Thomas D Stuckey7, Akiko Maehara8, Roxana Mehran9, Ajay J Kirtane8, Gregg W Stone8. 1. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA; Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada. Electronic address: pgenereux@crf.org. 2. Icahn School of Medicine at Mount Sinai, New York, NY, USA. 3. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden. 4. Dipartimento Cardiovascolare, Policlinico S. Orsola, University of Bologna, Bologna, Italy. 5. Helios Amper-Klinikum, Dachau, Germany. 6. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; Montefiore Medical Center, Bronx, NY, USA. 7. LeBauer-Brodie Center for Cardiovascular Research and Education/Cone Health, Greensboro, NC, USA. 8. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA. 9. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Abstract
BACKGROUND: Risk stratification after percutaneous coronary intervention (PCI) is mainly based on demographics and clinical presentation (stable coronary artery disease [CAD] vs. acute coronary syndromes [ACS]). We investigated the impact of PCI extent and complexity on 2-year clinical outcomes after successful implantation of drug-eluting stents (DES) and whether this effect is influenced by clinical presentation and/or high platelet reactivity (HPR) on clopidogrel. METHODS AND RESULTS: Patients from the prospective, multicenter Assessment of Dual Antiplatelet Therapy with Drug-Eluting Stents study were stratified according to PCI complexity, with complex PCI (C-PCI) defined as ≥3 stents implanted, bifurcation PCI with 2 stents, rotational atherectomy use for severely calcified lesions, or left main or saphenous vein graft (SVG) PCI. Major adverse cardiac events (MACE; cardiac death, myocardial infarction, and stent thrombosis) were compared at 2-year follow-up in patients with and without C-PCI. Successful DES PCI was performed in 8582 patients-2255 (26.3%) with C-PCI. C-PCI was independently associated with higher 2-year risk of MACE (adjusted HR [adjHR]: 1.56; 95%CI: 1.29-1.89; p<0.0001), MI (adjHR: 1.71; 95%CI: 1.37-2.14; p<0.0001), and ST (adjHR: 2.26; 95%CI: 1.42-3.59; p=0.0006). The association between C-PCI vs. non-C-PCI and the risk of MI and ST was greater in stable CAD than in ACS (Pinteraction=0.04 and 0.03, respectively). SVG PCI, 2-stent bifurcation treatment, and implantation of ≥3 stents were independently associated with MACE. CONCLUSIONS: Patients undergoing extensive and more complex PCI experienced worse outcomes after successful PCI. Considering the extent and complexity of PCI revascularization may improve risk stratification.
BACKGROUND: Risk stratification after percutaneous coronary intervention (PCI) is mainly based on demographics and clinical presentation (stable coronary artery disease [CAD] vs. acute coronary syndromes [ACS]). We investigated the impact of PCI extent and complexity on 2-year clinical outcomes after successful implantation of drug-eluting stents (DES) and whether this effect is influenced by clinical presentation and/or high platelet reactivity (HPR) on clopidogrel. METHODS AND RESULTS:Patients from the prospective, multicenter Assessment of Dual Antiplatelet Therapy with Drug-Eluting Stents study were stratified according to PCI complexity, with complex PCI (C-PCI) defined as ≥3 stents implanted, bifurcation PCI with 2 stents, rotational atherectomy use for severely calcified lesions, or left main or saphenous vein graft (SVG) PCI. Major adverse cardiac events (MACE; cardiac death, myocardial infarction, and stent thrombosis) were compared at 2-year follow-up in patients with and without C-PCI. Successful DES PCI was performed in 8582 patients-2255 (26.3%) with C-PCI. C-PCI was independently associated with higher 2-year risk of MACE (adjusted HR [adjHR]: 1.56; 95%CI: 1.29-1.89; p<0.0001), MI (adjHR: 1.71; 95%CI: 1.37-2.14; p<0.0001), and ST (adjHR: 2.26; 95%CI: 1.42-3.59; p=0.0006). The association between C-PCI vs. non-C-PCI and the risk of MI and ST was greater in stable CAD than in ACS (Pinteraction=0.04 and 0.03, respectively). SVG PCI, 2-stent bifurcation treatment, and implantation of ≥3 stents were independently associated with MACE. CONCLUSIONS:Patients undergoing extensive and more complex PCI experienced worse outcomes after successful PCI. Considering the extent and complexity of PCI revascularization may improve risk stratification.
Authors: Rayyan Hemetsberger; Mohammad Abdelghani; Ralph Toelg; Hector M Garcia-Garcia; Serdar Farhan; Nader Mankerious; Karim Elbasha; Abdelhakim Allali; Stephan Windecker; Thierry Lefèvre; Shigeru Saito; David Kandzari; Ron Waksman; Gert Richardt Journal: Clin Res Cardiol Date: 2022-02-25 Impact factor: 5.460
Authors: Mark Kheifets; Shelly Abigail Vons; Tamir Bental; Hana Vaknin-Assa; Gabriel Greenberg; Abed Samara; Pablo Codner; Guy Wittberg; Yeela Talmor Barkan; Leor Perl; Ran Kornowski; Amos Levi Journal: Front Cardiovasc Med Date: 2022-06-24