Predictors of outcomes after PCI with incomplete revascularization: Impact of CTO and LAD vessel.
Catheter Cardiovasc Interv
; 2024 Jul 15.
Article
in En
| MEDLINE
| ID: mdl-39007455
ABSTRACT
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.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Language:
En
Journal:
Catheter Cardiovasc Interv
Journal subject:
CARDIOLOGIA
Year:
2024
Document type:
Article
Affiliation country:
Estados Unidos
Country of publication:
Estados Unidos