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Int J Cardiol. 2018 Oct 1;268:61-67. doi: 10.1016/j.ijcard.2018.03.103.

Impact of percutaneous coronary intervention extent, complexity and platelet reactivity on outcomes after drug-eluting stent implantation.

Author information

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.

KEYWORDS:

Acute coronary syndromes; Complex percutaneous coronary intervention; Coronary artery disease; Drug-eluting stents; Dual antiplatelet therapy; Stent thrombosis

PMID:
30041804
DOI:
10.1016/j.ijcard.2018.03.103
[Indexed for MEDLINE]

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