Relation of percutaneous coronary intervention of complex lesions to clinical outcomes (from the NHLBI Dynamic Registry)

• Published in: The American journal of cardiology Vol. 90; no. 3; pp. 216 - 221
• Main Authors: Wilensky, Robert L, Selzer, Faith, Johnston, Janet, Laskey, Warren K, Klugherz, Bruce D, Block, Peter, Cohen, Howard, Detre, Katherine, Williams, David O
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-08-2002; Elsevier; Elsevier Limited
• Subjects: Angioplasty; Angioplasty, Balloon, Coronary; Bifurcations; Biological and medical sciences; Blood clots; Calcification; Cardiology; Clinical outcomes; Complications; Confidence intervals; Coronary artery; Coronary Artery Bypass; Coronary Disease - mortality; Coronary Disease - pathology; Coronary Disease - therapy; Death; Diseases of the cardiovascular system; Embolization; Female; Heart; Heart surgery; Humans; Intervention; Lesions; Lungs; Male; Medical sciences; Middle Aged; Mortality; Myocardial infarction; Occlusion; Patients; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Success; Surgery; Thrombosis; Treatment Outcome; Human; Prognosis; Pathophysiology; Treatment efficiency; Mortality; Coronary artery; Clinical form; Instrumentation therapy; Cardiovascular disease; Coronary heart disease; Morbidity; Complexity; Treatment
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/S0002-9149(02)02457-8

Advances in percutaneous coronary intervention (PCI) have reduced complications but expanded indications. We used the National Heart, Lung, and Blood Insitute Dynamic Registry to determine clinical outcomes up to 1 year after PCI in 2,839 patients with at least 1 treated complex lesion (defined as a lesion showing evidence of thrombus, calcification, bifurcation or ostial location, or chronic occlusion) and 1,790 patients with only simple lesions treated. Complex lesion interventions were associated (p <0.05) with more sustained major dissections, distal embolization, side branch occlusion, and persistent flow reduction. Patients with treated complex lesions had a lower procedural success rate (93.8% vs 97.3%, p <0.001) and increased in-hospital rates (p <0.001) of death (2.0% vs 0.6%), death/myocardial infarction [MI] (5.2% vs 2.4%), or death/MI/coronary artery bypass graft [CABG] surgery (6.5% vs 2.9%). After adjustment for potential confounders, patients treated for multiple complex lesions were more likely to experience the in-hospital combined end points of death/MI (odds ratio 3.22, 95% confidence interval 2.10 to 4.92), or death/MI/CABG (odds ratio 2.55, 95% confidence interval 1.71 to 3.80). At 1 year, patients with treated complex lesions were more likely (p <0.001) to die (6.2% vs 3.7%), suffer death/MI (11.7% vs 7.5%), or death/MI/CABG/repeat PCI (27.2% vs 23.4%). Patients treated for multiple complex lesions were approximately 50% more likely to die or to have major adverse events than with patients only treated for simple lesions. An increased in-hospital adverse clinical event rate was independently noted for thrombotic, bifurcation, and calcified lesions, and bifurcation lesions had worse long-term event rates.