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

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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.

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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.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan

    Hirohisa Endo, Tomotaka Dohi, Katsumi Miyauchi, Takehiro Funamizu, Shinichiro Doi, Yoshiteru Kato, Iwao Okai, Hiroshi Iwata, Shinya Okazaki, Kikuo Isoda & Hiroyuki Daida

  2. Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni-shi, Shizuoka, Japan

    Daigo Takahashi, Jun Shitara & Hideki Wada

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  1. Hirohisa Endo
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Correspondence to Tomotaka Dohi.

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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

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