Advertisement

Clinical impact of complex percutaneous coronary intervention in patients with coronary artery disease

  • Hirohisa Endo
  • Tomotaka DohiEmail author
  • Katsumi Miyauchi
  • Daigo Takahashi
  • Takehiro Funamizu
  • Jun Shitara
  • Hideki Wada
  • Shinichiro Doi
  • Yoshiteru Kato
  • Iwao Okai
  • Hiroshi Iwata
  • Shinya Okazaki
  • Kikuo Isoda
  • Hiroyuki Daida
Original Article
  • 37 Downloads

Abstract

For the revascularization of patients with clinical and anatomical complexities, several technical skills are often required. However, the prognostic effect of complex percutaneous coronary intervention (C-PCI) on the clinical outcomes is not well known. The aim of this study was to investigate the relationship between the C-PCI and mid-term clinical outcomes. We assessed 1062 patients who underwent PCI with newer-generation drug-eluting stent and stratified the patients according to whether they had complex PCI (C-PCI, n = 358) or non-complex PCI (non-C-PCI, n = 704). C-PCI was defined as a procedure with at least 1 of the following features: 3 vessels treated, ≥ 3 stents per vessel implanted, ≥ 3 lesions treated, use of a 2-stent technique, the total stent length per vessel > 60 mm, chronic total occlusion, unprotected left main coronary artery stenting, and rotational atherectomy use. All-cause death and major adverse cardiac and cerebrovascular events (MACCE; cardiovascular death, non-fatal myocardial infarction, and non-fatal ischemic stroke) were evaluated. The median follow-up period was 1.9 (0.8–3.0) years. The baseline SYNTAX score was significantly higher in the C-PCI group than in the non-C-PCI group [20 (14–27) vs. 10 (6–17), p < 0.001]. Kaplan–Meier analysis showed that the cumulative incidences of all-cause death (log-rank p = 0.12) and MACCE (log-rank p = 0.64) did not differ between the two groups. On multivariable Cox analysis, C-PCI did not adversely affect the clinical outcomes. Despite a high rate of anatomically complex coronary lesions, the patients who underwent C-PCI had comparable “hard” clinical outcomes with those of non-C-PCI.

Keywords

Complex percutaneous coronary intervention Complete revascularization Residual SYNTAX score 

Notes

Acknowledgements

We wish to express our gratitude to the staff of the Department of Cardiovascular Medicine at Juntendo University. We also wish to thank Ms. Yumi Nozawa for the data management.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Mohr FW, Morice M-C, Kappetein AP, Feldman TE, Ståhle E, Colombo A, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet. 2013;381:629–38.CrossRefGoogle Scholar
  2. 2.
    Neeland IJ, Patel RS, Eshtehardi P, Dhawan S, McDaniel MC, Rab ST, et al. Coronary angiographic scoring systems: an evaluation of their equivalence and validity. Am Heart J. 2012;164:547–52.CrossRefGoogle Scholar
  3. 3.
    Serruys PW, Morice M-C, Kappetein AP, Colombo A, Holmes DR, Mack MJ, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009;360:961–72.CrossRefGoogle Scholar
  4. 4.
    Cockburn J, Hildick-Smith D, Cotton J, Doshi S, Hanratty C, Ludman P, et al. Contemporary clinical outcomes of patients treated with or without rotational coronary atherectomy—an analysis of the UK central cardiac audit database. Int J Cardiol. 2014;170:381–7.CrossRefGoogle Scholar
  5. 5.
    Patel VG, Brayton KM, Tamayo A, Mogabgab O, Michael TT, Lo N, et al. Angiographic success and procedural complications in patients undergoing percutaneous coronary chronic total occlusion interventions: a weighted meta-analysis of 18,061 patients from 65 studies. JACC Cardiovasc. Interv. 2013;6:128–36.CrossRefGoogle Scholar
  6. 6.
    Kirtane AJ, Doshi D, Leon MB, Lasala JM, Ohman EM, O’neill WW, et al. Treatment of higher-risk patients with an indication for revascularization: evolution within the field of contemporary percutaneous coronary intervention. Circulation. 2016;134:422–31.CrossRefGoogle Scholar
  7. 7.
    Giustino G, Chieffo A, Palmerini T, Valgimigli M, Feres F, Abizaid A, et al. Efficacy and safety of dual antiplatelet therapy after complex PCI. J Am Coll Cardiol. 2016;68:1851–64.CrossRefGoogle Scholar
  8. 8.
    Sianos G, Morel M-A, Kappetein AP, Morice M-C, Colombo A, Dawkins K, et al. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention. 2005;1:219–27.Google Scholar
  9. 9.
    Malkin CJ, George V, Ghobrial M, Krishnan A, Siotia A, Raina T, et al. Residual SYNTAX score after PCI for triple vessel coronary artery disease: quantifying the adverse effect of incomplete revascularisation. EuroIntervention. 2013;8:1286–95.CrossRefGoogle Scholar
  10. 10.
    Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol. 2018;72:2231–64.CrossRefGoogle Scholar
  11. 11.
    Okai I, Dohi T, Okazaki S, Jujo K, Nakashima M, Otsuki H, et al. Clinical characteristics and long-term outcomes of rotational atherectomy—J2T multicenter registry—. Circ J. 2018;82:369–75.CrossRefGoogle Scholar
  12. 12.
    Cohen MG, Ghatak A, Kleiman NS, Naidu SS, Massaro JM, Kirtane AJ, et al. Optimizing rotational atherectomy in high-risk percutaneous coronary interventions: Insights from the PROTECT ΙΙ study. Catheter. Cardiovasc. Interv. 2014;83:1057–64.CrossRefGoogle Scholar
  13. 13.
    Généreux P, Giustino G, Redfors B, Palmerini T, Witzenbichler B, Weisz G, et al. Impact of percutaneous coronary intervention extent, complexity and platelet reactivity on outcomes after drug-eluting stent implantation. Int J Cardiol. 2018;268:61–7.CrossRefGoogle Scholar
  14. 14.
    Kobayashi Y, Nam C-W, Tonino PA, Kimura T, De Bruyne B, Pijls NH, et al. The prognostic value of residual coronary stenoses after functionally complete revascularization. J Am Coll Cardiol. 2016;67:1701–11.CrossRefGoogle Scholar
  15. 15.
    Farooq V, Serruys PW, Bourantas CV, Zhang Y, Muramatsu T, Feldman T, et al. Quantification of incomplete revascularization and its association with 5-year mortality in the synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) trial validation of the residual SYNTAX score. Circulation. 2013;128:141–51.CrossRefGoogle Scholar
  16. 16.
    Kimura T, Morimoto T, Furukawa Y, Nakagawa Y, Kadota K, Iwabuchi M, et al. Long-term safety and efficacy of sirolimus-eluting stents versus bare-metal stents in real world clinical practice in Japan. Cardiovasc. Intervent. Ther. 2011;26:234–45.CrossRefGoogle Scholar
  17. 17.
    Park KW, Kang S-H, Velders MA, Shin D-H, Hahn S, Lim W-H, et al. Safety and efficacy of everolimus-versus sirolimus-eluting stents: a systematic review and meta-analysis of 11 randomized trials. Am Heart J. 2013;165:241–50.CrossRefGoogle Scholar
  18. 18.
    Lee PH, Lee S-W, Yun S-C, Bae J, Ahn J-M, Park D-W, et al. Full metal jacket with drug-eluting stents for coronary chronic total occlusion. JACC Cardiovasc. Interv. 2017;10:1405–12.CrossRefGoogle Scholar
  19. 19.
    Chen S-L, Zhang J-J, Han Y, Kan J, Chen L, Qiu C, et al. Double kissing crush versus provisional stenting for left main distal bifurcation lesions: DKCRUSH-V randomized trial. J Am Coll Cardiol. 2017;70:2605–17.CrossRefGoogle Scholar
  20. 20.
    Stone GW, Sabik JF, Serruys PW, Simonton CA, Généreux P, Puskas J, et al. Everolimus-eluting stents or bypass surgery for left main coronary artery disease. N Engl J Med. 2016;375:2223–35.CrossRefGoogle Scholar
  21. 21.
    Fajadet J, Capodanno D, Stone GW. Management of left main disease: an update. Eur Heart J. 2018;40:1454–66.CrossRefGoogle Scholar
  22. 22.
    Patel MR, Calhoon JH, Dehmer GJ, Grantham JA, Maddox TM, Maron DJ, et al. ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 appropriate use criteria for coronary revascularization in patients with stable ischemic heart disease: a report of the American College of Cardiology appropriate use criteria task force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2017;69:2212–41.CrossRefGoogle Scholar
  23. 23.
    Kang S-H, Chae I-H, Park J-J, Lee HS, Kang D-Y, Hwang S-S, et al. Stent thrombosis with drug-eluting stents and bioresorbable scaffolds: evidence from a network meta-analysis of 147 trials. JACC Cardiovasc. Interv. 2016;9:1203–12.CrossRefGoogle Scholar
  24. 24.
    Tada T, Byrne RA, Simunovic I, King LA, Cassese S, Joner M, et al. Risk of stent thrombosis among bare-metal stents, first-generation drug-eluting stents, and second-generation drug-eluting stents: results from a registry of 18,334 patients. JACC Cardiovasc. Interv. 2013;6:1267–74.CrossRefGoogle Scholar
  25. 25.
    Palmerini T, Biondi-Zoccai G, Della Riva D, Stettler C, Sangiorgi D, D’Ascenzo F, et al. Stent thrombosis with drug-eluting and bare-metal stents: evidence from a comprehensive network meta-analysis. The Lancet. 2012;379:1393–402.CrossRefGoogle Scholar
  26. 26.
    Wada H, Mattson PC, Iwata H. Stent or scaffold thrombosis: past, current and future perspectives. EMJ Int Cardiol. 2017;5:55–61.Google Scholar

Copyright information

© Japanese Association of Cardiovascular Intervention and Therapeutics 2019

Authors and Affiliations

  • Hirohisa Endo
    • 1
  • Tomotaka Dohi
    • 1
    Email author
  • Katsumi Miyauchi
    • 1
  • Daigo Takahashi
    • 2
  • Takehiro Funamizu
    • 1
  • Jun Shitara
    • 2
  • Hideki Wada
    • 2
  • Shinichiro Doi
    • 1
  • Yoshiteru Kato
    • 1
  • Iwao Okai
    • 1
  • Hiroshi Iwata
    • 1
  • Shinya Okazaki
    • 1
  • Kikuo Isoda
    • 1
  • Hiroyuki Daida
    • 1
  1. 1.Department of Cardiovascular MedicineJuntendo University Graduate School of MedicineTokyoJapan
  2. 2.Department of Cardiovascular MedicineJuntendo University Shizuoka HospitalShizuokaJapan

Personalised recommendations