Key result
Complex percutaneous coronary intervention was associated with a significantly higher 1-year risk of major adverse cardiac events compared to non-complex procedures (HR 1.30), although outcomes for complex procedures improved over the 12-year study period.
Why the study?
Increasing PCI utilization and complexity prompted an investigation into temporal trends in PCI complexity and the outcomes of complex PCI.
Does complex PCI compared to non-complex PCI, and its temporal evolution over a 12-year period, affect 1-year mortality and MACE?
Cohort (n=20,301)
No
Does complex PCI compared to non-complex PCI, and its temporal evolution over a 12-year period, affect 1-year mortality and MACE?
Hazard Ratio: 1.3 (95% CI 1.19–1.42)
Absolute Event Rate: 15.4% vs 10.3%
p-value: p=<0.001
While complex PCI is associated with higher 1-year MACE and mortality compared to non-complex PCI, temporal trends over a 12-year period show an increasing utilization of complex procedures alongside improved 1-year MACE rates in recent years.
Complex PCI warrants careful risk stratification due to higher MACE; leaves open whether temporal gains will equalize outcomes in trials.
Background Accumulated experience combined with technological advancements in percutaneous coronary interventions (PCI) over the past four decades, has led to a gradual increase in PCI utilization and complexity. We aimed to investigate the temporal trends in PCI complexity and the outcomes of complex PCI (C-PCI) in our institution. Methods We analyzed 20,301 consecutive PCI procedures performed over a 12-year period. C-PCI was defined as a procedure involving at least one of the following: Chronic total occlusion (CTO), left main (LM), bifurcation or saphenous vein graft (SVG) PCI. Four periods of 3-year time intervals were defined (2008–10, 2011–2013, 2014–2016, 2017–2019), and temporal trends in the rate and outcomes of C-PCI within these intervals were studied. Endpoints included mortality and major adverse cardiac events [MACE: death, acute myocardial infarction (MI), and target vessel revascularization (TVR)] at 1 year. Results A total of 5,647 (27.8%) C-PCI procedures were performed. The rate of C-PCI has risen significantly since 2,017 (31.2%, p < 0.01), driven mainly by bifurcation and LM interventions ( p < 0.01). At 1-year, rates of death, acute MI, TVR and MACE, were all significantly higher in the C-PCI group (8.8 vs. 5.1%, 5.6 vs. 4.5%, 5.5 vs. 4.0%, 17.2 vs. 12.2%, p < 0.001 for all, respectively), as compared to the non-complex group. C-PCI preformed in the latter half of the study period (2014–2019) were associated with improved 1-year TVR (4.4% and 4.8% vs. 6.7% and 7.1%, p = 0.01, respectively) and MACE (13.8% and 13.5% vs. 17.3% and 18.2%, p = 0.001, respectively) rates compared to the earlier period (2007–2013). Death rate had not significantly declined with time. Conclusion In the current cohort, we have detected a temporal increase in PCI complexity coupled with improved 1-year clinical outcomes in C-PCI.
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Kheifets et al. (2022) conducted a cohort in Coronary artery disease requiring percutaneous coronary intervention (n=20,301). Complex percutaneous coronary intervention (C-PCI) vs. Non-complex percutaneous coronary intervention was evaluated on Major adverse cardiac events (MACE: death, acute MI, and TVR) at 1 year (HR 1.30, 95% CI 1.19-1.42, p=<0.001). Complex percutaneous coronary intervention was associated with a significantly higher 1-year risk of major adverse cardiac events compared to non-complex procedures (HR 1.30), although outcomes for complex procedures improved over the 12-year study period.
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