Guglielmo Gallone1, Fabrizio D'Ascenzo1, Federico Conrotto1, Francesco Costa2, Davide Capodanno3, Saverio Muscoli4, Alaide Chieffo5, Imori Yoichi6, Mauro Pennacchi7, Giorgio Quadri8, Ivan Nuñez-Gil9, Pier Paolo Bocchino1, Francesco Piroli1, Ovidio De Filippo1, Cristina Rolfo8, Wojciech Wojakowski10, Daniela Trabattoni11, Zenon Huczek12, Giuseppe Venuti3, Andrea Montabone13, Andrea Rognoni14, Radoslaw Parma10, Filippo Figini15, Satoru Mitomo5, Giacomo Boccuzzi13, Alessio Mattesini16, Enrico Cerrato8, Wojciech Wańha10, Grzegorz Smolka10, Bernardo Cortese17, Nicola Ryan9, Mario Bo18, Carlo di Mario16, Ferdinando Varbella8, Francesco Burzotta19, Imad Sheiban15, Javier Escaned9, Gerard Helft20, Gaetano Maria De Ferrari1. 1. Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy. 2. Department of Clinical and Experimental Medicine, Policlinic "G. Martino", University of Messina, Messina, Italy. 3. Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy. 4. Department of Cardiovascular Disease, Tor Vergata University of Rome, Rome, Italy. 5. Unit of Cardiovascular Interventions, IRCCS San Raffaele Hospital, Milan, Italy. 6. Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan. 7. Department of Cardiovascular, Respiratory and Morphologic Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy. 8. Department of Cardiology, Infermi Hospital, Rivoli, Italy. 9. Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain. 10. Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland. 11. Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS, Milan, Italy. 12. Medical University of Warsaw, Warsaw, Poland. 13. Department of Cardiology, S.G. Bosco Hospital, Torino, Italy. 14. Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy. 15. Pederzoli Hospital, Peschiera del Garda, Italy. 16. Division of Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy. 17. Interventional Cardiology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy. 18. Section of Geriatrics, Department of Medical Sciences, Università degli Studi di Torino, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy. 19. Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy. 20. Pierre and Marie Curie University, Paris, France.
Abstract
BACKGROUND: The PARIS risk score (PARIS-rs) and percutaneous coronary intervention complexity (PCI-c) predict clinical and procedural residual ischemic risk following PCI. Their accuracy in patients undergoing unprotected left main (ULM) or bifurcation PCI has not been assessed. METHODS: The predictive performances of the PARIS-rs (categorized as low, intermediate, and high) and PCI-c (according to guideline-endorsed criteria) were evaluated in 3,002 patients undergoing ULM/bifurcation PCI with very thin strut stents. RESULTS: After 16 (12-22) months, increasing PARIS-rs (8.8% vs. 14.1% vs. 27.4%, p < .001) and PCI-c (15.2% vs. 11%, p = .025) were associated with higher rates of major adverse cardiac events ([MACE], a composite of death, myocardial infarction [MI], and target vessel revascularization), driven by MI/death for PARIS-rs and target lesion revascularization/stent thrombosis for PCI-c (area under the curves for MACE: PARIS-rs 0.60 vs. PCI-c 0.52, p-for-difference < .001). PCI-c accuracy for MACE was higher in low-clinical-risk patients; while PARIS-rs was more accurate in low-procedural-risk patients. ≥12-month dual antiplatelet therapy (DAPT) was associated with a lower MACE rate in high PARIS-rs patients, (adjusted-hazard ratio 0.42 [95% CI: 0.22-0.83], p = .012), with no benefit in low to intermediate PARIS-rs patients. No incremental benefit with longer DAPT was observed in complex PCI. CONCLUSIONS: In the setting of ULM/bifurcation PCI, the residual ischemic risk is better predicted by a clinical risk estimator than by PCI complexity, which rather appears to reflect stent/procedure-related events. Careful procedural risk estimation is warranted in patients at low clinical risk, where PCI complexity may substantially contribute to the overall residual ischemic risk.
BACKGROUND: The PARIS risk score (PARIS-rs) and percutaneous coronary intervention complexity (PCI-c) predict clinical and procedural residual ischemic risk following PCI. Their accuracy in patients undergoing unprotected left main (ULM) or bifurcation PCI has not been assessed. METHODS: The predictive performances of the PARIS-rs (categorized as low, intermediate, and high) and PCI-c (according to guideline-endorsed criteria) were evaluated in 3,002 patients undergoing ULM/bifurcation PCI with very thin strut stents. RESULTS: After 16 (12-22) months, increasing PARIS-rs (8.8% vs. 14.1% vs. 27.4%, p < .001) and PCI-c (15.2% vs. 11%, p = .025) were associated with higher rates of major adverse cardiac events ([MACE], a composite of death, myocardial infarction [MI], and target vessel revascularization), driven by MI/death for PARIS-rs and target lesion revascularization/stent thrombosis for PCI-c (area under the curves for MACE: PARIS-rs 0.60 vs. PCI-c 0.52, p-for-difference < .001). PCI-c accuracy for MACE was higher in low-clinical-risk patients; while PARIS-rs was more accurate in low-procedural-risk patients. ≥12-month dual antiplatelet therapy (DAPT) was associated with a lower MACE rate in high PARIS-rs patients, (adjusted-hazard ratio 0.42 [95% CI: 0.22-0.83], p = .012), with no benefit in low to intermediate PARIS-rs patients. No incremental benefit with longer DAPT was observed in complex PCI. CONCLUSIONS: In the setting of ULM/bifurcation PCI, the residual ischemic risk is better predicted by a clinical risk estimator than by PCI complexity, which rather appears to reflect stent/procedure-related events. Careful procedural risk estimation is warranted in patients at low clinical risk, where PCI complexity may substantially contribute to the overall residual ischemic risk.
Authors: Ilias Nikolakopoulos; Evangelia Vemmou; Judit Karacsonyi; Lorenzo Azzalini; Brian A Bergmark; Yiannis S Chatzizisis; Allison B Hall; Jason Wollmuth; Kevin Croce; Hani Jneid; Bavana V Rangan; M Nicholas Burke; Emmanouil S Brilakis Journal: J Invasive Cardiol Date: 2022-01 Impact factor: 2.022
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
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