Impact of coronary lesion complexity in percutaneous coronary intervention: One-year outcomes from the large, multicentre e-Ultimaster registry

Mohamed M.O. Polad J. Hildick-Smith D. Bizeau O. Baisebenov R.K. Roffi M. Iñiguez-Romo A. Chevalier B. von Birgelen C. Roguin A. Aminian A. Angioi M. Mamas M.A.
2021 Europa Group

EuroIntervention
2021 #16 Issue 7 603 - 612 pp.

Aims: The present study sought to examine the prevalence, clinical characteristics and one-year outcomes of patients undergoing percutaneous coronary intervention (PCI) to complex lesions (multivessel PCI, ≥3 stents, ≥3 lesions, bifurcation with ≥2 stents, total stent length >60 mm or chronic total occlusion [CTO]) in a prospective multicentre registry. Methods and results: Using the e-Ultimaster multicentre registry, a post hoc subgroup analysis was performed on 35,839 patients undergoing PCI, stratified by procedure complexity, and further by number and type of complex features. Overall, complex PCI patients (n=9,793, 27.3%) were older, more comorbid and were associated with an increased hazard ratio (HR) of the composite endpoint at one year (target lesion failure [TLF]: 1.41 [1.25; 1.59]), driven by an increased hazard of cardiac death (1.28 [1.05; 1.55]), target vessel myocardial infarction (1.48 [1.18; 1.86]) and clinically driven target lesion revascularisation. The hazard of complications increased with the rising number of complex features (3-6 vs 1-2 vs none) for all outcomes. All individual complex features were associated with an increased hazard of composite complications (except CTO) and definite/probable stent thrombosis. Conclusions: Overall, complex PCI is associated with an increased risk of mortality and complications at one year. The number and types of complex features have differing impacts on long-term outcomes.

Bifurcation , Chronic coronary total occlusion , Clinical research , Drug-eluting stent , Multiple vessel disease , Risk stratification

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Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, Newcastle, United Kingdom
Jeroen Bosch Hospital, ‘s-Hertogenbosch, Netherlands
Sussex Cardiac Centre, Brighton and Sussex University Hospital, Brighton, United Kingdom
Centre Hospitalier Régional Orléans-La-Source, Orléans, France
Regional Cardiology Center, Pavlodar, Kazakhstan
Geneva University Hospitals, Geneva, Switzerland
Hospital Álvaro Cunqueiro, Vigo, Spain
Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France
Twente, Medisch Spectrum Twente, Enschede, Netherlands
Hillel Yaffe Medical Center, Hadera, Israel
Centre Hospitalier Universitaire Charleroi, Charleroi, Belgium
Clinique Pasteur, Essey-les-Nancy, France

Keele Cardiovascular Research Group
Jeroen Bosch Hospital
Sussex Cardiac Centre
Centre Hospitalier Régional Orléans-La-Source
Regional Cardiology Center
Geneva University Hospitals
Hospital Álvaro Cunqueiro
Ramsay Générale de Santé
Twente
Hillel Yaffe Medical Center
Centre Hospitalier Universitaire Charleroi
Clinique Pasteur

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