Endo Hirohisa, Dohi Tomotaka, Miyauchi Katsumi, Takahashi Daigo, Funamizu Takehiro, Shitara Jun, Wada Hideki, Doi Shinichiro, Kato Yoshiteru, Okai Iwao, Iwata Hiroshi, Okazaki Shinya, Isoda Kikuo, Daida Hiroyuki
Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan.
Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni-shi, Shizuoka, Japan.
Cardiovasc Interv Ther. 2020 Jul;35(3):234-241. doi: 10.1007/s12928-019-00608-7. Epub 2019 Jul 26.
For the revascularization of patients with clinical and anatomical complexities, several technical skills are often required. However, the prognostic effect of complex percutaneous coronary intervention (C-PCI) on the clinical outcomes is not well known. The aim of this study was to investigate the relationship between the C-PCI and mid-term clinical outcomes. We assessed 1062 patients who underwent PCI with newer-generation drug-eluting stent and stratified the patients according to whether they had complex PCI (C-PCI, n = 358) or non-complex PCI (non-C-PCI, n = 704). C-PCI was defined as a procedure with at least 1 of the following features: 3 vessels treated, ≥ 3 stents per vessel implanted, ≥ 3 lesions treated, use of a 2-stent technique, the total stent length per vessel > 60 mm, chronic total occlusion, unprotected left main coronary artery stenting, and rotational atherectomy use. All-cause death and major adverse cardiac and cerebrovascular events (MACCE; cardiovascular death, non-fatal myocardial infarction, and non-fatal ischemic stroke) were evaluated. The median follow-up period was 1.9 (0.8-3.0) years. The baseline SYNTAX score was significantly higher in the C-PCI group than in the non-C-PCI group [20 (14-27) vs. 10 (6-17), p < 0.001]. Kaplan-Meier analysis showed that the cumulative incidences of all-cause death (log-rank p = 0.12) and MACCE (log-rank p = 0.64) did not differ between the two groups. On multivariable Cox analysis, C-PCI did not adversely affect the clinical outcomes. Despite a high rate of anatomically complex coronary lesions, the patients who underwent C-PCI had comparable "hard" clinical outcomes with those of non-C-PCI.
对于具有临床和解剖复杂性的患者进行血运重建，通常需要多种技术技能。然而，复杂经皮冠状动脉介入治疗（C-PCI）对临床结局的预后影响尚不明确。本研究的目的是探讨C-PCI与中期临床结局之间的关系。我们评估了1062例行新一代药物洗脱支架PCI的患者，并根据他们是否接受复杂PCI（C-PCI，n = 358）或非复杂PCI（非C-PCI，n = 704）对患者进行分层。C-PCI被定义为具有以下至少一项特征的手术：治疗3支血管、每支血管植入≥3枚支架、治疗≥3处病变、使用双支架技术、每支血管总支架长度>60 mm、慢性完全闭塞、无保护左主干冠状动脉支架置入以及使用旋磨术。评估全因死亡和主要不良心脑血管事件（MACCE；心血管死亡、非致命性心肌梗死和非致命性缺血性卒中）。中位随访期为1.9（0.8 - 3.0）年。C-PCI组的基线SYNTAX评分显著高于非C-PCI组[20（14 - 27）对10（6 - 17），p < 0.001]。Kaplan-Meier分析显示，两组间全因死亡（对数秩p = 0.12）和MACCE（对数秩p = 0.64）的累积发生率无差异。多变量Cox分析显示，C-PCI对临床结局没有不利影响。尽管解剖学上复杂冠状动脉病变的发生率很高，但接受C-PCI的患者与非C-PCI患者的“硬”临床结局相当。
