Impact of percutaneous coronary intervention extent, complexity and platelet reactivity on outcomes after drug-eluting stent implantation

Philippe Genereux, Gennaro Giustino, Björn Redfors, Tullio Palmerini, Bernhard Witzenbichler, Giora Weisz, Thomas D. Stuckey, Akiko Maehara, Roxana Mehran, Ajay J. Kirtane, Gregg W. Stone

Research output: Contribution to journalArticle

4 Citations (Scopus)

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 (P interaction = 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.

Original languageEnglish (US)
Pages (from-to)61-67
Number of pages7
JournalInternational Journal of Cardiology
Volume268
DOIs
StatePublished - Oct 1 2018

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Drug-Eluting Stents
Percutaneous Coronary Intervention
Blood Platelets
Stents
clopidogrel
Saphenous Vein
Acute Coronary Syndrome
Coronary Artery Disease
Coronary Atherectomy
Transplants
Thrombosis

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Genereux, Philippe ; Giustino, Gennaro ; Redfors, Björn ; Palmerini, Tullio ; Witzenbichler, Bernhard ; Weisz, Giora ; Stuckey, Thomas D. ; Maehara, Akiko ; Mehran, Roxana ; Kirtane, Ajay J. ; Stone, Gregg W. / Impact of percutaneous coronary intervention extent, complexity and platelet reactivity on outcomes after drug-eluting stent implantation. In: International Journal of Cardiology. 2018 ; Vol. 268. pp. 61-67.
@article{130c0797915443bb9b4a2a9c5ca7ba2f,
title = "Impact of percutaneous coronary intervention extent, complexity and platelet reactivity on outcomes after drug-eluting stent implantation",
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 (P interaction = 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.",
author = "Philippe Genereux and Gennaro Giustino and Bj{\"o}rn Redfors and Tullio Palmerini and Bernhard Witzenbichler and Giora Weisz and Stuckey, {Thomas D.} and Akiko Maehara and Roxana Mehran and Kirtane, {Ajay J.} and Stone, {Gregg W.}",
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Genereux, P, Giustino, G, Redfors, B, Palmerini, T, Witzenbichler, B, Weisz, G, Stuckey, TD, Maehara, A, Mehran, R, Kirtane, AJ & Stone, GW 2018, 'Impact of percutaneous coronary intervention extent, complexity and platelet reactivity on outcomes after drug-eluting stent implantation', International Journal of Cardiology, vol. 268, pp. 61-67. https://doi.org/10.1016/j.ijcard.2018.03.103

Impact of percutaneous coronary intervention extent, complexity and platelet reactivity on outcomes after drug-eluting stent implantation. / Genereux, Philippe; Giustino, Gennaro; Redfors, Björn; Palmerini, Tullio; Witzenbichler, Bernhard; Weisz, Giora; Stuckey, Thomas D.; Maehara, Akiko; Mehran, Roxana; Kirtane, Ajay J.; Stone, Gregg W.

In: International Journal of Cardiology, Vol. 268, 01.10.2018, p. 61-67.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Impact of percutaneous coronary intervention extent, complexity and platelet reactivity on outcomes after drug-eluting stent implantation

AU - Genereux, Philippe

AU - Giustino, Gennaro

AU - Redfors, Björn

AU - Palmerini, Tullio

AU - Witzenbichler, Bernhard

AU - Weisz, Giora

AU - Stuckey, Thomas D.

AU - Maehara, Akiko

AU - Mehran, Roxana

AU - Kirtane, Ajay J.

AU - Stone, Gregg W.

PY - 2018/10/1

Y1 - 2018/10/1

N2 - 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 (P interaction = 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.

AB - 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 (P interaction = 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.

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U2 - 10.1016/j.ijcard.2018.03.103

DO - 10.1016/j.ijcard.2018.03.103

M3 - Article

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EP - 67

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

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