Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan.
Catheter Cardiovasc Interv. 2021 May 1;97(6):E758-E770. doi: 10.1002/ccd.29335. Epub 2020 Oct 16.
To evaluate utility of the complex percutaneous coronary intervention (PCI) criteria in real-world practice.
Applicability of procedural complexity criteria for risk stratification has not been adequately evaluated in real-world practice.
Among 13,087 patients undergoing first PCI in the CREDO-Kyoto registry cohort-2, the study population consisted of 7,871 patients after excluding patients with acute myocardial infarction and those without stent implantation. Complex PCI was defined as PCI, which fulfills at least one of the followings: three vessels treated, > = 3 stents implanted, > = 3 lesions treated, bifurcation with two stents, >60 mm total stent lengths, and target of chronic total occlusion.
The cumulative incidences of and adjusted risks for the primary ischemic (myocardial infarction/ischemic stroke), and bleeding (GUSTO moderate/severe) endpoints were significantly higher in patients with complex PCI (N = 2,777 [35%]) than in those with noncomplex PCI (N = 5,094 [65%]) (15.4% vs. 10.9%, log-rank p < .001; odds ratio (OR): 1.53, 95% confidence interval (CI): 1.31-1.79, p < .001, and 11.9% vs. 9.9%, log-rank p = .004; OR: 1.24, 95% CI: 1.05-1.46, p = .01). In the 30-day landmark analysis, the higher risks of patients with complex PCI for ischemic and major bleeding events were only seen within 30 days after PCI (ischemic; within 30 days: HR: 2.19, 95% CI: 1.79-2.69, p < .001; beyond 30 days: HR: 1.11, 95% CI: 0.92-1.34, p = .26, and bleeding; within 30 days: HR: 1.56, 95% CI: 1.13-2.16, p = .007; beyond 30 days: HR: 1.11, 95% CI: 0.94-1.31, p = .22).
Patients with complex PCI as compared with patients with noncomplex PCI had a higher risk for both ischemic and bleeding events mainly within 30 days after PCI.
评估复杂经皮冠状动脉介入治疗（PCI）标准在真实世界实践中的应用价值。
在真实世界实践中，尚未充分评估手术复杂性标准在风险分层中的适用性。
在 CREDO-Kyoto 注册队列-2 中，对 13087 例首次接受 PCI 的患者进行分析，研究人群排除了急性心肌梗死患者和未植入支架的患者，共包括 7871 例患者。复杂 PCI 定义为满足以下至少一项标准的 PCI：三支血管病变、植入支架数量≥3 个、病变数量≥3 个、分叉病变植入 2 个支架、总支架长度＞60mm 和慢性完全闭塞病变。
与非复杂 PCI（N=5094[65%]）相比，复杂 PCI 患者（N=2777[35%]）的主要缺血（心肌梗死/缺血性卒中）和出血（GUSTO 中度/重度）终点的累积发生率和调整风险更高（15.4%比 10.9%，log-rank p＜0.001；优势比（OR）：1.53，95%置信区间（CI）：1.31-1.79，p＜0.001，11.9%比 9.9%，log-rank p=0.004；OR：1.24，95%CI：1.05-1.46，p=0.01）。在 30 天时间点分析中，仅在 PCI 后 30 天内观察到复杂 PCI 患者的缺血和主要出血事件风险更高（缺血；30 天内：HR：2.19，95%CI：1.79-2.69，p＜0.001；30 天后：HR：1.11，95%CI：0.92-1.34，p=0.26；出血；30 天内：HR：1.56，95%CI：1.13-2.16，p=0.007；30 天后：HR：1.11，95%CI：0.94-1.31，p=0.22）。
与非复杂 PCI 相比，复杂 PCI 患者在 PCI 后 30 天内主要发生缺血和出血事件的风险更高。
