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2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines SGLT-2 Inhibitors and Cardiovascular Risk: An Analysis of CVD-REAL Novel developments in revascularization for left main coronary artery disease Tissue characterisation of atherosclerotic plaque in the left main: an in vivo intravascular ultrasound radiofrequency data analysis Evaluation and Management of Right-Sided Heart Failure: A Scientific Statement From the American Heart Association Poor R-wave progression as a predictor of sudden cardiac death in general population and subjects with coronary artery disease Clopidogrel Pharmacogenetics: State-of-the-Art Review and the TAILOR-PCI Study The spectrum of heart failure: value of left ventricular ejection fraction and its moving trajectories A pragmatic approach to the use of inotropes for the management of acute and advanced heart failure: An expert panel consensus Diuretic Therapy for Patients With Heart Failure JACC State-of-the-Art Review

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.