Mortality Following Nonemergent, Uncomplicated Target Lesion Revascularization After Percutaneous Coronary Intervention: An Individual Patient Data Pooled Analysis of 21 Randomized Trials and 32,524 Patients

Tullio Palmerini, Diego Della Riva, Giuseppe Biondi-Zoccai, Martin B. Leon, Patrick W. Serruys, Pieter C. Smits, Clemens von Birgelen, Ori Ben-Yehuda, Philippe Généreux, Antonio G. Bruno, Paul Jenkins, Gregg W. Stone

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objectives: This study sought to investigate the impact of nonemergent, uncomplicated target lesion revascularization (TLR) on the risk of long-term mortality after percutaneous coronary intervention (PCI). Background: Restenosis requiring TLR after PCI is generally considered a benign event. Methods: The study pooled patient-level data from 21 randomized trials. Subjects dying the same day as or the day after the TLR procedure as well as those with myocardial infarction (MI) the day before, the same day as or the day after TLR were excluded. The primary endpoint of the study was all-cause mortality. Results: The dataset included 32,524 patients who were stratified according to whether repeat TLR was performed during follow-up. During a median follow-up of 37 months, 2,330 (7.2%) patients underwent a nonemergent, uncomplicated TLR procedure. After adjusting for potential confounders, TLR was an independent predictor of mortality (hazard ratio: 1.23, 95% confidence interval: 1.04 to 1.45; p = 0.02). Patients undergoing nonemergent, uncomplicated TLR had significantly higher rates of non–procedure-related MI compared with those without TVR. Among patients undergoing elective TLR, MI occurring after TLR was an independent predictor of mortality (hazard ratio: 3.82; 95% confidence interval: 2.44 to 5.99; p < 0.0001). Conclusions: Nonemergent, uncomplicated TLR after PCI is an independent predictor of long-term mortality, an association in part explained by higher rates of MI occurring after TLR. Efforts aimed at reducing TLR risk may translate into prognostic benefits including reduced rates of MI and survival.

Original languageEnglish (US)
Pages (from-to)892-902
Number of pages11
JournalJACC: Cardiovascular Interventions
Volume11
Issue number9
DOIs
StatePublished - May 14 2018

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Percutaneous Coronary Intervention
Myocardial Infarction
Mortality
Confidence Intervals
Survival

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Palmerini, Tullio ; Della Riva, Diego ; Biondi-Zoccai, Giuseppe ; Leon, Martin B. ; Serruys, Patrick W. ; Smits, Pieter C. ; von Birgelen, Clemens ; Ben-Yehuda, Ori ; Généreux, Philippe ; Bruno, Antonio G. ; Jenkins, Paul ; Stone, Gregg W. / Mortality Following Nonemergent, Uncomplicated Target Lesion Revascularization After Percutaneous Coronary Intervention : An Individual Patient Data Pooled Analysis of 21 Randomized Trials and 32,524 Patients. In: JACC: Cardiovascular Interventions. 2018 ; Vol. 11, No. 9. pp. 892-902.
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title = "Mortality Following Nonemergent, Uncomplicated Target Lesion Revascularization After Percutaneous Coronary Intervention: An Individual Patient Data Pooled Analysis of 21 Randomized Trials and 32,524 Patients",
abstract = "Objectives: This study sought to investigate the impact of nonemergent, uncomplicated target lesion revascularization (TLR) on the risk of long-term mortality after percutaneous coronary intervention (PCI). Background: Restenosis requiring TLR after PCI is generally considered a benign event. Methods: The study pooled patient-level data from 21 randomized trials. Subjects dying the same day as or the day after the TLR procedure as well as those with myocardial infarction (MI) the day before, the same day as or the day after TLR were excluded. The primary endpoint of the study was all-cause mortality. Results: The dataset included 32,524 patients who were stratified according to whether repeat TLR was performed during follow-up. During a median follow-up of 37 months, 2,330 (7.2{\%}) patients underwent a nonemergent, uncomplicated TLR procedure. After adjusting for potential confounders, TLR was an independent predictor of mortality (hazard ratio: 1.23, 95{\%} confidence interval: 1.04 to 1.45; p = 0.02). Patients undergoing nonemergent, uncomplicated TLR had significantly higher rates of non–procedure-related MI compared with those without TVR. Among patients undergoing elective TLR, MI occurring after TLR was an independent predictor of mortality (hazard ratio: 3.82; 95{\%} confidence interval: 2.44 to 5.99; p < 0.0001). Conclusions: Nonemergent, uncomplicated TLR after PCI is an independent predictor of long-term mortality, an association in part explained by higher rates of MI occurring after TLR. Efforts aimed at reducing TLR risk may translate into prognostic benefits including reduced rates of MI and survival.",
author = "Tullio Palmerini and {Della Riva}, Diego and Giuseppe Biondi-Zoccai and Leon, {Martin B.} and Serruys, {Patrick W.} and Smits, {Pieter C.} and {von Birgelen}, Clemens and Ori Ben-Yehuda and Philippe G{\'e}n{\'e}reux and Bruno, {Antonio G.} and Paul Jenkins and Stone, {Gregg W.}",
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Mortality Following Nonemergent, Uncomplicated Target Lesion Revascularization After Percutaneous Coronary Intervention : An Individual Patient Data Pooled Analysis of 21 Randomized Trials and 32,524 Patients. / Palmerini, Tullio; Della Riva, Diego; Biondi-Zoccai, Giuseppe; Leon, Martin B.; Serruys, Patrick W.; Smits, Pieter C.; von Birgelen, Clemens; Ben-Yehuda, Ori; Généreux, Philippe; Bruno, Antonio G.; Jenkins, Paul; Stone, Gregg W.

In: JACC: Cardiovascular Interventions, Vol. 11, No. 9, 14.05.2018, p. 892-902.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Mortality Following Nonemergent, Uncomplicated Target Lesion Revascularization After Percutaneous Coronary Intervention

T2 - An Individual Patient Data Pooled Analysis of 21 Randomized Trials and 32,524 Patients

AU - Palmerini, Tullio

AU - Della Riva, Diego

AU - Biondi-Zoccai, Giuseppe

AU - Leon, Martin B.

AU - Serruys, Patrick W.

AU - Smits, Pieter C.

AU - von Birgelen, Clemens

AU - Ben-Yehuda, Ori

AU - Généreux, Philippe

AU - Bruno, Antonio G.

AU - Jenkins, Paul

AU - Stone, Gregg W.

PY - 2018/5/14

Y1 - 2018/5/14

N2 - Objectives: This study sought to investigate the impact of nonemergent, uncomplicated target lesion revascularization (TLR) on the risk of long-term mortality after percutaneous coronary intervention (PCI). Background: Restenosis requiring TLR after PCI is generally considered a benign event. Methods: The study pooled patient-level data from 21 randomized trials. Subjects dying the same day as or the day after the TLR procedure as well as those with myocardial infarction (MI) the day before, the same day as or the day after TLR were excluded. The primary endpoint of the study was all-cause mortality. Results: The dataset included 32,524 patients who were stratified according to whether repeat TLR was performed during follow-up. During a median follow-up of 37 months, 2,330 (7.2%) patients underwent a nonemergent, uncomplicated TLR procedure. After adjusting for potential confounders, TLR was an independent predictor of mortality (hazard ratio: 1.23, 95% confidence interval: 1.04 to 1.45; p = 0.02). Patients undergoing nonemergent, uncomplicated TLR had significantly higher rates of non–procedure-related MI compared with those without TVR. Among patients undergoing elective TLR, MI occurring after TLR was an independent predictor of mortality (hazard ratio: 3.82; 95% confidence interval: 2.44 to 5.99; p < 0.0001). Conclusions: Nonemergent, uncomplicated TLR after PCI is an independent predictor of long-term mortality, an association in part explained by higher rates of MI occurring after TLR. Efforts aimed at reducing TLR risk may translate into prognostic benefits including reduced rates of MI and survival.

AB - Objectives: This study sought to investigate the impact of nonemergent, uncomplicated target lesion revascularization (TLR) on the risk of long-term mortality after percutaneous coronary intervention (PCI). Background: Restenosis requiring TLR after PCI is generally considered a benign event. Methods: The study pooled patient-level data from 21 randomized trials. Subjects dying the same day as or the day after the TLR procedure as well as those with myocardial infarction (MI) the day before, the same day as or the day after TLR were excluded. The primary endpoint of the study was all-cause mortality. Results: The dataset included 32,524 patients who were stratified according to whether repeat TLR was performed during follow-up. During a median follow-up of 37 months, 2,330 (7.2%) patients underwent a nonemergent, uncomplicated TLR procedure. After adjusting for potential confounders, TLR was an independent predictor of mortality (hazard ratio: 1.23, 95% confidence interval: 1.04 to 1.45; p = 0.02). Patients undergoing nonemergent, uncomplicated TLR had significantly higher rates of non–procedure-related MI compared with those without TVR. Among patients undergoing elective TLR, MI occurring after TLR was an independent predictor of mortality (hazard ratio: 3.82; 95% confidence interval: 2.44 to 5.99; p < 0.0001). Conclusions: Nonemergent, uncomplicated TLR after PCI is an independent predictor of long-term mortality, an association in part explained by higher rates of MI occurring after TLR. Efforts aimed at reducing TLR risk may translate into prognostic benefits including reduced rates of MI and survival.

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