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.
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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.
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Endo, H., Dohi, T., Miyauchi, K. et al. Clinical impact of complex percutaneous coronary intervention in patients with coronary artery disease. Cardiovasc Interv and Ther 35, 234–241 (2020). https://doi.org/10.1007/s12928-019-00608-7
- Complex percutaneous coronary intervention
- Complete revascularization
- Residual SYNTAX score