Carloalberto Biolè1, Zenon Huczek2, Ivan Nuñez-Gil3, Giacomo Boccuzzi4, Michele Autelli5, Antonio Montefusco5, Daniela Trabattoni6, Nicola Ryan3, Giuseppe Venuti7, Yoichi Imori8, Hitoshi Takano8, Junya Matsuda8, Wataru Shimizu8, Saverio Muscoli9, Andrea Montabone10, Wojciech Wojakowski11, Andrea Rognoni12, Gerard Helft13, Diego Gallo14, Radoslaw Parma2, Leonardo De Luca15, Filippo Figini16, Satoru Mitomo17, Mauro Pennone5, Alessio Mattesini10, Christian Templin18, Giorgio Quadri19, Wojciech Wańha11, Enrico Cerrato19, Grzegorz Smolka11, Marcin Protasiewicz20, Wiktor Kuliczkowski20, Cristina Rolfo19, Bernardo Cortese21, Davide Capodanno7, Alaide Chieffo17, Umberto Morbiducci14, Mario Iannaccone5, Sebastiano Gili18, Carlo di Mario10, Maurizio D'Amico5, Francesco Romeo22, Thomas F Lüscher18, Imad Sheiban16, Javier Escaned3, Ferdinando Varbella19, Fabrizio D'Ascenzo5. 1. Division of Cardiology, Departement of Internal Medicine, Città della Salute e della Scienza, Turin, Italy. Electronic address: carloalberto.biole@gmail.com. 2. University Clinical Hospital, Warsaw, Poland. 3. Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain. 4. Dipartimento di Cardiologia, Ospedale San Giovanni Bosco, Italy. 5. Division of Cardiology, Departement of Internal Medicine, Città della Salute e della Scienza, Turin, Italy. 6. Department of Cardiovascular Sciences, IRCCS Centro Cardiologico Monzino, Milan, Italy; University of Milan, Milan, Italy. 7. Division of Cardiology, Cardio-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria "Policlinico-Vittorio Emanuele", Catania, Italy. 8. Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, Japan. 9. San Raffaele Scientific Institute, Milan, Italy; Department of Medicine, Università degli Studi di Roma 'Tor Vergata', Rome, Italy. 10. Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy. 11. Department of Cardiology, Medical University of Silesia, Katowice, Poland. 12. Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy. 13. Pierre and Marie Curie University, Paris, France. 14. Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Italy. 15. Division of Cardiology, S. Giovanni Evangelista Hospital, Tivoli, Rome, Italy. 16. Pederzoli Hospital, Peschiera del Garda, Italy. 17. San Raffaele Scientific Institute, Milan, Italy. 18. Division of Cardiology, Universityszpital of Zurich, Switzerland. 19. Department of Cardiology, Infermi Hospital, Rivoli, Italy; Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy. 20. Medical University of Wroclaw, Wroclaw, Poland. 21. Interventional Cardiology, ASST Fatebenefratelli-Sacco, Milano, Italy. 22. Department of Medicine, Università degli Studi di Roma 'Tor Vergata', Rome, Italy.
Abstract
INTRODUCTION: Percutaneous coronary intervention (PCI) for complex lesions, including unprotected left main (ULM) and bifurcations, is gaining a relevant role in treating coronary artery disease with good outcomes, also thanks to new generation stents. The daily risk of adverse cardiovascular events and their temporal distribution after these procedures is not known. METHODS: All consecutive patients presenting with a critical lesion of ULM or bifurcation treated with very thin struts stents, enrolled in the RAIN-Cardiogroup VII study, were analyzed. The daily risk of major acute cardiovascular events (MACE), target lesion revascularization (TLR) and stent thrombosis (ST) and their temporal distribution in the first year of follow-up was the primary endpoint. Differences among subgroups (ULM, patient presentation, kind of stent polymer) were the secondary endpoint. RESULTS: 2745 patients were included, mean age 68 ± 11 years, 33.3% diabetics, 54.5% had an acute coronary syndrome (ACS); 88.5% of treated lesions were bifurcations, 27.2% ULM. Average daily risk was 0.022% for MACE, 0.005% for TLR and 0.004% for ST, in the first year. Bimodal distribution of adverse events, especially TLR, with an early peak in the first 50 days and a late one after 150 days, was observed. Patients with ULM presented a significantly higher daily risk of events, and ACS patients presented higher MACE risk. No difference emerged according to the type of stent polymer. CONCLUSIONS: The daily risk of adverse events in the first year after complex PCI in our study is acceptably low. PCI on ULM carries a higher risk of complications.
INTRODUCTION: Percutaneous coronary intervention (PCI) for complex lesions, including unprotected left main (ULM) and bifurcations, is gaining a relevant role in treating coronary artery disease with good outcomes, also thanks to new generation stents. The daily risk of adverse cardiovascular events and their temporal distribution after these procedures is not known. METHODS: All consecutive patients presenting with a critical lesion of ULM or bifurcation treated with very thin struts stents, enrolled in the RAIN-Cardiogroup VII study, were analyzed. The daily risk of major acute cardiovascular events (MACE), target lesion revascularization (TLR) and stent thrombosis (ST) and their temporal distribution in the first year of follow-up was the primary endpoint. Differences among subgroups (ULM, patient presentation, kind of stent polymer) were the secondary endpoint. RESULTS: 2745 patients were included, mean age 68 ± 11 years, 33.3% diabetics, 54.5% had an acute coronary syndrome (ACS); 88.5% of treated lesions were bifurcations, 27.2% ULM. Average daily risk was 0.022% for MACE, 0.005% for TLR and 0.004% for ST, in the first year. Bimodal distribution of adverse events, especially TLR, with an early peak in the first 50 days and a late one after 150 days, was observed. Patients with ULM presented a significantly higher daily risk of events, and ACS patients presented higher MACE risk. No difference emerged according to the type of stent polymer. CONCLUSIONS: The daily risk of adverse events in the first year after complex PCI in our study is acceptably low. PCI on ULM carries a higher risk of complications.
Authors: Jacopo Burrello; Guglielmo Gallone; Alessio Burrello; Daniele Jahier Pagliari; Eline H Ploumen; Mario Iannaccone; Leonardo De Luca; Paolo Zocca; Giuseppe Patti; Enrico Cerrato; Wojciech Wojakowski; Giuseppe Venuti; Ovidio De Filippo; Alessio Mattesini; Nicola Ryan; Gérard Helft; Saverio Muscoli; Jing Kan; Imad Sheiban; Radoslaw Parma; Daniela Trabattoni; Massimo Giammaria; Alessandra Truffa; Francesco Piroli; Yoichi Imori; Bernardo Cortese; Pierluigi Omedè; Federico Conrotto; Shao-Liang Chen; Javier Escaned; Rosaly A Buiten; Clemens Von Birgelen; Paolo Mulatero; Gaetano Maria De Ferrari; Silvia Monticone; Fabrizio D'Ascenzo Journal: J Pers Med Date: 2022-06-17