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Clinical and Vessel Characteristics Associated With Hard Outcomes After PCI and Their Combined Prognostic Implications. | LitMetric

AI Article Synopsis

  • This study investigates the risks of cardiac death or myocardial infarction in patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents, using data from 2081 patients.
  • It identifies four adverse clinical features (age ≥65, diabetes, chronic kidney disease, and low left ventricular ejection fraction) and two adverse vessel features (poor fractional flow reserve and long total stent length) that independently predict these hard outcomes.
  • The research suggests that evaluating both clinical and vessel characteristics together can improve risk assessment after PCI, as having more adverse factors increases the likelihood of serious complications over a two-year period.

Article Abstract

Background Cardiac death or myocardial infarction still occurs in patients undergoing contemporary percutaneous coronary intervention (PCI). We aimed to identify adverse clinical and vessel characteristics related to hard outcomes after PCI and to investigate their individual and combined prognostic implications. Methods and Results From an individual patient data meta-analysis of 17 cohorts of patients who underwent post-PCI fractional flow reserve measurement after drug-eluting stent implantation, 2081 patients with available clinical and vessel characteristics were analyzed. The primary outcome was cardiac death or target-vessel myocardial infarction at 2 years. The mean age of patients was 64.2±10.2 years, and the mean angiographic percent diameter stenosis was 63.9%±14.3%. Among 11 clinical and 8 vessel features, 4 adverse clinical characteristics (age ≥65 years, diabetes, chronic kidney disease, and left ventricular ejection fraction <50%) and 2 adverse vessel characteristics (post-PCI fractional flow reserve ≤0.80 and total stent length ≥54 mm) were identified to independently predict the primary outcome (all <0.05). The number of adverse vessel characteristics had additive predictability for the primary end point to that of adverse clinical characteristics (area under the curve 0.72 versus 0.78; =0.03) and vice versa (area under the curve 0.68 versus 0.78; =0.03). The cumulative event rate increased in the order of none, either, and both of adverse clinical characteristics ≥2 and adverse vessel characteristics ≥1 (0.3%, 2.4%, and 5.3%; for trend <0.01). Conclusions In patients undergoing drug-eluting stent implantation, adverse clinical and vessel characteristics were associated with the risk of cardiac death or target-vessel myocardial infarction. Because these characteristics showed independent and additive prognostic value, their integrative assessment can optimize post-PCI risk stratification. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04684043. www.crd.york.ac.uk/prospero/. Unique Identifier: CRD42021234748.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10547308PMC
http://dx.doi.org/10.1161/JAHA.123.030572DOI Listing

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