Predictors of outcomes after PCI with incomplete revascularization: Impact of CTO and LAD vessel.

Autor: Kuno T; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.; Department of Medicine, Mount Sinai Beth Israel Hospital, New York, New York, USA.; Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA., Weisz G; Division of Cardiology, Columbia University Medical Center, NewYork Presbyterian Hospital, New York, New York, USA., Généreux P; Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA., Claessen BE; Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands., Shechter M; The Leviev Cardiothoracic & Vascular Center, Sheba Medical Center, Tel Hashomer, Israel., Alexander KP; Duke Clinical Research Institute, Durham, North Carolina, USA., James SK; Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden., Ohman EM; Duke Clinical Research Institute, Durham, North Carolina, USA., Dressler O; Cardiovascular Research Foundation, New York, New York, USA., Mehran R; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Ben-Yehuda O; Sulpizio Cardiovascular Institute, University of California San Diego, San Diego, California, USA., Stone GW; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Jazyk: angličtina
Zdroj: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions [Catheter Cardiovasc Interv] 2024 Sep; Vol. 104 (3), pp. 483-491. Date of Electronic Publication: 2024 Jul 15.
DOI: 10.1002/ccd.31142
Abstrakt: Background: Incomplete revascularization (ICR) after percutaneous coronary intervention (PCI) is associated with mortality and morbidity.
Aim: We sought to investigate whether ICR in the left anterior descending artery (LAD) is worse than ICR of the right coronary artery (RCA) or left circumflex artery (LCX); and whether ICR in patients with a chronic total occlusion (CTO) is worse than in those without.
Methods: In the RIVER-PCI trial, 2651 patients with ICR after PCI were randomly assigned to ranolazine or placebo. Angiograms were assessed at an independent core laboratory in 2501 patients (94.3%). The primary endpoint was the composite of ischemia-driven revascularization or hospitalization.
Results: A total of 1664 patients (66.5%) had ICR involving the LAD, whereas 837 (33.5%) had ICR limited to the RCA or LCX. At median follow-up of 643 days, the primary endpoint occurred in 26.9% versus 26.5% of patients (adjusted HR [aHR]: 1.03, 95% confidence interval [CI]: 0.88-1.21). A nonrecanalized CTO was present in 854 patients (34.1%) with ICR after PCI. The primary endpoint occurred in 28.6% versus 25.9% of ICR patients with versus without a CTO (aHR: 1.10, 95% CI: 0.94-1.29). However, patients with a CTO had higher rates of ischemia-driven hospitalization without revascularization (aHR: 1.27, 95% CI: 1.04-1.56), heart failure hospitalization (aHR: 2.69, 95% CI: 1.61-4.59) and myocardial infarction (aHR: 1.46, 95% CI: 1.11-1.92) compared with those without.
Conclusions: The 2-year prognosis was similar in post-PCI patients with ICR whether the LAD was versus was not involved. ICR patients with a CTO had more frequent hospitalizations for ischemia and myocardial infarctions compared with those without.
(© 2024 Wiley Periodicals LLC.)
Databáze: MEDLINE
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