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Selection of stenting approach for coronary bifurcation lesions Open sesame technique in percutaneous coronary intervention for ST-elevation myocardial infarction Association of Body Mass Index With Lifetime Risk of Cardiovascular Disease and Compression of Morbidity Comparative Effectiveness of β-Blocker Use Beyond 3 Years After Myocardial Infarction and Long-Term Outcomes Among Elderly Patients Cardiopulmonary Exercise Testing: What Is its Value? Invasive Management of Acute Myocardial Infarction Complicated by Cardiogenic Shock: A Scientific Statement From the American Heart Association Long-term outcomes after myocardial infarction in middle-aged and older patients with congenital heart disease-a nationwide study Refractory Angina: From Pathophysiology to New Therapeutic Nonpharmacological Technologies Another Nail in the Coffin for Intra-Aortic Balloon Counterpulsion in Acute Myocardial Infarction With Cardiogenic Shock Effects of clopidogrel vs. prasugrel vs. ticagrelor on endothelial function, inflammatory parameters, and platelet function in patients with acute coronary syndrome undergoing coronary artery stenting: a randomized, blinded, parallel study

Original Research2020 Jun 25;EIJ-D-20-00361.

JOURNAL:Eurointervention. Article Link

Impact of Coronary Lesion Complexity in Percutaneous Coronary Intervention: One-Year Outcomes From the Large, Multicentre e-Ultimaster Registry

MO Mohamed, J Polad, D Hildick-Smith et al. Keywords: complex PCI; outcome

ABSTRACT

AIMS -  The present study sought to examine the prevalence, clinical characteristics and one-year outcomes of patients undergoing percutaneous coronary intervention (PCI) to complex lesions (multivessel PCI, 3 stents, 3 lesions, bifurcation with 2 stents, total stent length >60 mm or chronic total occlusion [CTO]) in a prospective multicentre registry.

 

METHODS AND RESULTS -  Using the e-Ultimaster multicentre registry, a post hoc subgroup analysis was performed on 35,839 patients undergoing PCI, stratified by procedure complexity, and further by number and type of complex features. Overall, complex PCI patients (n=9,793, 27.3%) were older, more comorbid and were associated with an increased hazard ratio (HR) of the composite endpoint at one year (target lesion failure [TLF]: 1.41 [1.25; 1.59]), driven by an increased hazard of cardiac death (1.28 [1.05; 1.55]), target vessel myocardial infarction (1.48 [1.18; 1.86]) and clinically driven target lesion revascularisation. The hazard of complications increased with the rising number of complex features (3-6 vs 1-2 vs none) for all outcomes. All individual complex features were associated with an increased hazard of composite complications (except CTO) and definite/probable stent thrombosis.

 

CONCLUSIONS -  Overall, complex PCI is associated with an increased risk of mortality and complications at one year. The number and types of complex features have differing impacts on long-term outcomes.