Impact of percutaneous coronary intervention extent, complexity and platelet reactivity on outcomes after drug-eluting stent implantation. (1st October 2018)

• Record Type: Journal Article
• Authors: Généreux, Philippe; Giustino, Gennaro; Redfors, Björn; Palmerini, Tullio; Witzenbichler, Bernhard; Weisz, Giora; Stuckey, Thomas D.; Maehara, Akiko; Mehran, Roxana; Kirtane, Ajay J.; Stone, Gregg W.
• Is Part Of: International journal of cardiology. Volume 268(2018)
• Page Start: 61
• Page End: 67
• Publication Date: 2018-10-01
• Subjects: Complex percutaneous coronary intervention -- Drug-eluting stents -- Stent thrombosis -- Coronary artery disease -- Acute coronary syndromes -- Dual antiplatelet therapy; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2018.03.103
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Risk stratification after percutaneous coronary intervention (PCI) is mainly based on demographics and clinical presentation (stable coronary artery disease [CAD] vs. acute coronary syndromes [ACS]). We investigated the impact of PCI extent and complexity on 2-year clinical outcomes after successful implantation of drug-eluting stents (DES) and whether this effect is influenced by clinical presentation and/or high platelet reactivity (HPR) on clopidogrel. Methods and results: Patients from the prospective, multicenter Assessment of Dual Antiplatelet Therapy with Drug-Eluting Stents study were stratified according to PCI complexity, with complex PCI (C-PCI) defined as ≥3 stents implanted, bifurcation PCI with 2 stents, rotational atherectomy use for severely calcified lesions, or left main or saphenous vein graft (SVG) PCI. Major adverse cardiac events (MACE; cardiac death, myocardial infarction, and stent thrombosis) were compared at 2-year follow-up in patients with and without C-PCI. Successful DES PCI was performed in 8582 patients—2255 (26.3%) with C-PCI. C-PCI was independently associated with higher 2-year risk of MACE (adjusted HR [adjHR]: 1.56; 95%CI: 1.29–1.89; p < 0.0001), MI (adjHR: 1.71; 95%CI: 1.37–2.14; p < 0.0001), and ST (adjHR: 2.26; 95%CI: 1.42–3.59; p = 0.0006). The association between C-PCI vs. non–C-PCI and the risk of MI and ST was greater in stable CAD than in ACS (Pinteraction = 0.04 and 0.03, respectively). SVG PCI, 2-stent bifurcation treatment, and implantation of ≥3 stents were independently associated with MACE. Conclusions: Patients undergoing extensive and more complex PCI experienced worse outcomes after successful PCI. Considering the extent and complexity of PCI revascularization may improve risk stratification. Highlights: Percutaneous coronary intervention (PCI) complexity is associated with the risk of adverse events after successful PCI. The risk of high platelet reactivity is additive to that of PCI complexity. Procedural complexity should be considered when risk stratifying patients after PCI.