The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Impact of coronary lesion complexity in percutaneous coronary intervention: one-year outcomes from the large, multicentre e-Ultimaster registry

;:. DOI: 10.4244/EIJ-D-20-00361

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.

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