Clinical Characteristics and Outcomes From Percutaneous Coronary Intervention of Last Remaining Coronary Artery: An Analysis From the British Cardiovascular Intervention Society Database.

Shoaib, Ahmad; Rashid, Muhammad; Kontopantelis, Evangelos; Sharp, Andrew; Fahy, Eoin F.; Nolan, James; Townend, John; Ludman, Peter; Ratib, Karim; Azam, Ziyad A.; Ahmad, Ayesha; McEntegart, Margaret; Mohamed, Mohamed; Kinnaird, Tim; Mamas, Mamas A.

Abstract

BACKGROUND: Patients with complex high-risk coronary anatomy, such as those with a last remaining patent vessel (LRPV), are increasingly revascularized with percutaneous coronary intervention (PCI) in contemporary practice. There are limited data on the outcomes of these high-risk procedures. METHODS: We analyzed a large longitudinal PCI cohort (2007-2014, n=501?841) from the British Cardiovascular Intervention Society database. Clinical, demographic, procedural, and outcome data were analyzed by dividing patients into 2 groups; LRPV group (n=2432) and all other PCI groups (n=506?691). RESULTS: Patients in the LRPV PCI group were older, had more comorbidities, and higher prevalence of moderate-severe left ventricular systolic dysfunction. Mortality was higher in the LRPV PCI group during hospital admission (12 % versus 1.5 %, P<0.001), at 30 days (15% versus 2%, P<0.001), and at one-year (24% versus 5%, P<0.001). In a propensity score matching analysis the adjusted risk of mortality during index admission (odds ratio, 2.05 [95% CI, 1.65-2.44], P<0.001), at 30 days (odds ratio, 2.13 [95% CI, 1.78-2.5], P<0.001), at 1 year (odds ratio, 1.81 [95% CI, 1.59-2.03], P<0.001), and in-hospital major adverse cardiovascular events (odds ratio, 1.8 [95% CI, 1.42-2.19], P<0.001) were higher in LRPV PCI group as compared to control group. In sensitivity analyses, similar clinical outcomes were observed irrespective of which major epicardial coronary artery was treated. CONCLUSIONS: In this contemporary cohort, patients who had PCI to their LRPV had a higher-risk profile and more adverse clinical outcomes, irrespective of the vessel treated.

Citation

Shoaib, A., Rashid, M., Kontopantelis, E., Sharp, A., Fahy, E. F., Nolan, J., …Mamas, M. A. (2020). Clinical Characteristics and Outcomes From Percutaneous Coronary Intervention of Last Remaining Coronary Artery: An Analysis From the British Cardiovascular Intervention Society Database. Circulation: Cardiovascular Interventions, 13(9), Article e009049. https://doi.org/10.1161/CIRCINTERVENTIONS.120.009049

• Journal Article Type: Article
• Acceptance Date: Jun 16, 2020
• Publication Date: Sep 2, 2020
• Journal: Circulation: Cardiovascular Interventions
• Print ISSN: 1941-7640
• Publisher: American Heart Association
• Peer Reviewed: Peer Reviewed
• Volume: 13
• Issue: 9
• Article Number: e009049
• DOI: https://doi.org/10.1161/CIRCINTERVENTIONS.120.009049
• Keywords: percutaneous coronary intervention; mortality; myocardial infarction; prevalence
• Publisher URL: https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.120.009049