Mohamed O. Mohamed1, MRCP; Jawed Polad2, MD; David Hildick-Smith3, MD, FRCP; Olivier Bizeau4, MD; Ruslan K. Baisebenov5, MD; Marco Roffi6, MD; Andrés Íñiguez-Romo7, MD; Bernard Chevalier8, MD; Clemens von Birgelen9, MD, PhD; Ariel Roguin10, MD, PhD; Adel Aminian11, MD; Michael Angioi12, MD; Mamas A. Mamas1, DPhil, MRCP
1. Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, Newcastle, United Kingdom; 2. Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands; 3. Sussex Cardiac Centre, Brighton and Sussex University Hospital, Brighton, United Kingdom; 4. Centre Hospitalier Régional Orléans-La-Source, Orléans, France; 5. Regional Cardiology Center, Pavlodar, Kazakhstan; 6. Geneva University Hospitals, Geneva, Switzerland; 7. Hospital Álvaro Cunqueiro, Vigo, Spain; 8. Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France; 9. Twente, Medisch Spectrum Twente, Enschede, the Netherlands; 10. Hillel Yaffe Medical Center, Hadera, Israel; 11. Centre Hospitalier Universitaire Charleroi, Charleroi, Belgium; 12. Clinique Pasteur, Essey-les-Nancy, France
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.