Clinical and Vessel Characteristics Associated With Hard Outcomes After PCI and Their Combined Prognostic Implications
Background Cardiac death or myocardial infarction still occurs in patients undergoing contemporary percutaneous coronary intervention (PCI). We aimed to identify adverse clinical and vessel characteristics related to hard outcomes after PCI and to investigate their individual and combined prognostic...
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Wiley
2023-09-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.030572 |
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| author | Seokhun Yang Doyeon Hwang Jinlong Zhang Jiesuck Park Jun Pil Yun Joo Myung Lee Chang‐Wook Nam Eun‐Seok Shin Joon‐Hyung Doh Shao‐Liang Chen Tsunekazu Kakuta Gabor G. Toth Zsolt Piroth Nils P. Johnson Abdul Hakeem Barry F Uretsky Yohei Hokama Nobuhiro Tanaka Hong‐Seok Lim Tsuyoshi Ito Akiko Matsuo Lorenzo Azzalini Massoud A. Leesar Tara Neleman Nicolas M van Mieghem Roberto Diletti Joost Daemen Damien Collison Carlos Collet Bernard De Bruyne Bon‐Kwon Koo |
| author_facet | Seokhun Yang Doyeon Hwang Jinlong Zhang Jiesuck Park Jun Pil Yun Joo Myung Lee Chang‐Wook Nam Eun‐Seok Shin Joon‐Hyung Doh Shao‐Liang Chen Tsunekazu Kakuta Gabor G. Toth Zsolt Piroth Nils P. Johnson Abdul Hakeem Barry F Uretsky Yohei Hokama Nobuhiro Tanaka Hong‐Seok Lim Tsuyoshi Ito Akiko Matsuo Lorenzo Azzalini Massoud A. Leesar Tara Neleman Nicolas M van Mieghem Roberto Diletti Joost Daemen Damien Collison Carlos Collet Bernard De Bruyne Bon‐Kwon Koo |
| author_sort | Seokhun Yang |
| collection | DOAJ |
| description | Background Cardiac death or myocardial infarction still occurs in patients undergoing contemporary percutaneous coronary intervention (PCI). We aimed to identify adverse clinical and vessel characteristics related to hard outcomes after PCI and to investigate their individual and combined prognostic implications. Methods and Results From an individual patient data meta‐analysis of 17 cohorts of patients who underwent post‐PCI fractional flow reserve measurement after drug‐eluting stent implantation, 2081 patients with available clinical and vessel characteristics were analyzed. The primary outcome was cardiac death or target‐vessel myocardial infarction at 2 years. The mean age of patients was 64.2±10.2 years, and the mean angiographic percent diameter stenosis was 63.9%±14.3%. Among 11 clinical and 8 vessel features, 4 adverse clinical characteristics (age ≥65 years, diabetes, chronic kidney disease, and left ventricular ejection fraction <50%) and 2 adverse vessel characteristics (post‐PCI fractional flow reserve ≤0.80 and total stent length ≥54 mm) were identified to independently predict the primary outcome (all P<0.05). The number of adverse vessel characteristics had additive predictability for the primary end point to that of adverse clinical characteristics (area under the curve 0.72 versus 0.78; P=0.03) and vice versa (area under the curve 0.68 versus 0.78; P=0.03). The cumulative event rate increased in the order of none, either, and both of adverse clinical characteristics ≥2 and adverse vessel characteristics ≥1 (0.3%, 2.4%, and 5.3%; P for trend <0.01). Conclusions In patients undergoing drug‐eluting stent implantation, adverse clinical and vessel characteristics were associated with the risk of cardiac death or target‐vessel myocardial infarction. Because these characteristics showed independent and additive prognostic value, their integrative assessment can optimize post‐PCI risk stratification. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04684043. www.crd.york.ac.uk/prospero/. Unique Identifier: CRD42021234748. |
| first_indexed | 2024-03-12T01:51:02Z |
| format | Article |
| id | doaj.art-28fe27b88b4a46f58b5043449e36ad2b |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-12T01:51:02Z |
| publishDate | 2023-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-28fe27b88b4a46f58b5043449e36ad2b2023-09-08T12:39:35ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-09-01121710.1161/JAHA.123.030572Clinical and Vessel Characteristics Associated With Hard Outcomes After PCI and Their Combined Prognostic ImplicationsSeokhun Yang0Doyeon Hwang1Jinlong Zhang2Jiesuck Park3Jun Pil Yun4Joo Myung Lee5Chang‐Wook Nam6Eun‐Seok Shin7Joon‐Hyung Doh8Shao‐Liang Chen9Tsunekazu Kakuta10Gabor G. Toth11Zsolt Piroth12Nils P. Johnson13Abdul Hakeem14Barry F Uretsky15Yohei Hokama16Nobuhiro Tanaka17Hong‐Seok Lim18Tsuyoshi Ito19Akiko Matsuo20Lorenzo Azzalini21Massoud A. Leesar22Tara Neleman23Nicolas M van Mieghem24Roberto Diletti25Joost Daemen26Damien Collison27Carlos Collet28Bernard De Bruyne29Bon‐Kwon Koo30Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital, Seoul National University College of Medicine Seoul South KoreaDepartment of Internal Medicine and Cardiovascular Center Seoul National University Hospital, Seoul National University College of Medicine Seoul South KoreaDepartment of Cardiology The Second Affiliated Hospital of Zhejiang University School of Medicine Hangzhou ChinaDepartment of Internal Medicine and Cardiovascular Center Seoul National University Hospital, Seoul National University College of Medicine Seoul South KoreaDepartment of Internal Medicine and Cardiovascular Center Seoul National University Hospital, Seoul National University College of Medicine Seoul South KoreaDivision of Cardiology, Department of Internal Medicine Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul South KoreaDepartment of Medicine Keimyung University Dongsan Medical Center Daegu South KoreaDepartment of Cardiology Ulsan University Hospital, University of Ulsan College of Medicine Ulsan South KoreaDepartment of Medicine Inje University Ilsan Paik Hospital Goyang South KoreaDivision of Cardiology, Nanjing First Hospital Nanjing Medical University Nanjing ChinaDivision of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki JapanUniversity Heart Centre Graz, Medical University Graz Graz AustriaGottsegen Hungarian Institute of Cardiology Budapest HungaryDivision of Cardiology, Department of Medicine, Weatherhead PET Center For Preventing and Reversing Atherosclerosis University of Texas Medical School and Memorial Hermann Hospital Houston TXDivision of Cardiovascular Diseases & Hypertension, Robert Wood Johnson Medical School Rutgers University New Brunswick NJCentral Arkansas VA Health System/University of Arkansas for Medical Sciences Little Rock ARDepartment of Cardiology Tokyo Medical University Hachioji Medical Center Tokyo JapanDepartment of Cardiology Tokyo Medical University Hachioji Medical Center Tokyo JapanDepartment of Cardiology Ajou University School of Medicine Suwon South KoreaDepartment of Cardiology Nagoya City University Graduate School of Medical Sciences Nagoya JapanDepartment of Cardiology Kyoto Second Red Cross Hospital Kyoto JapanDivision of Cardiology, Department of Medicine University of Washington Seattle WADivision of Cardiovascular Diseases University of Alabama Birmingham ALDepartment of Interventional Cardiology Thoraxcenter, Erasmus University Medical Centre Rotterdam The NetherlandsDepartment of Interventional Cardiology Thoraxcenter, Erasmus University Medical Centre Rotterdam The NetherlandsDepartment of Interventional Cardiology Thoraxcenter, Erasmus University Medical Centre Rotterdam The NetherlandsDepartment of Interventional Cardiology Thoraxcenter, Erasmus University Medical Centre Rotterdam The NetherlandsWest of Scotland Regional Heart and Lung Centre, Golden Jubilee National Hospital Glasgow United KingdomCardiovascular Center Aalst Aalst BelgiumCardiovascular Center Aalst Aalst BelgiumDepartment of Internal Medicine and Cardiovascular Center Seoul National University Hospital, Seoul National University College of Medicine Seoul South KoreaBackground Cardiac death or myocardial infarction still occurs in patients undergoing contemporary percutaneous coronary intervention (PCI). We aimed to identify adverse clinical and vessel characteristics related to hard outcomes after PCI and to investigate their individual and combined prognostic implications. Methods and Results From an individual patient data meta‐analysis of 17 cohorts of patients who underwent post‐PCI fractional flow reserve measurement after drug‐eluting stent implantation, 2081 patients with available clinical and vessel characteristics were analyzed. The primary outcome was cardiac death or target‐vessel myocardial infarction at 2 years. The mean age of patients was 64.2±10.2 years, and the mean angiographic percent diameter stenosis was 63.9%±14.3%. Among 11 clinical and 8 vessel features, 4 adverse clinical characteristics (age ≥65 years, diabetes, chronic kidney disease, and left ventricular ejection fraction <50%) and 2 adverse vessel characteristics (post‐PCI fractional flow reserve ≤0.80 and total stent length ≥54 mm) were identified to independently predict the primary outcome (all P<0.05). The number of adverse vessel characteristics had additive predictability for the primary end point to that of adverse clinical characteristics (area under the curve 0.72 versus 0.78; P=0.03) and vice versa (area under the curve 0.68 versus 0.78; P=0.03). The cumulative event rate increased in the order of none, either, and both of adverse clinical characteristics ≥2 and adverse vessel characteristics ≥1 (0.3%, 2.4%, and 5.3%; P for trend <0.01). Conclusions In patients undergoing drug‐eluting stent implantation, adverse clinical and vessel characteristics were associated with the risk of cardiac death or target‐vessel myocardial infarction. Because these characteristics showed independent and additive prognostic value, their integrative assessment can optimize post‐PCI risk stratification. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04684043. www.crd.york.ac.uk/prospero/. Unique Identifier: CRD42021234748.https://www.ahajournals.org/doi/10.1161/JAHA.123.030572drug‐eluting stentfractional flow reserverisk stratification |
| spellingShingle | Seokhun Yang Doyeon Hwang Jinlong Zhang Jiesuck Park Jun Pil Yun Joo Myung Lee Chang‐Wook Nam Eun‐Seok Shin Joon‐Hyung Doh Shao‐Liang Chen Tsunekazu Kakuta Gabor G. Toth Zsolt Piroth Nils P. Johnson Abdul Hakeem Barry F Uretsky Yohei Hokama Nobuhiro Tanaka Hong‐Seok Lim Tsuyoshi Ito Akiko Matsuo Lorenzo Azzalini Massoud A. Leesar Tara Neleman Nicolas M van Mieghem Roberto Diletti Joost Daemen Damien Collison Carlos Collet Bernard De Bruyne Bon‐Kwon Koo Clinical and Vessel Characteristics Associated With Hard Outcomes After PCI and Their Combined Prognostic Implications Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease drug‐eluting stent fractional flow reserve risk stratification |
| title | Clinical and Vessel Characteristics Associated With Hard Outcomes After PCI and Their Combined Prognostic Implications |
| title_full | Clinical and Vessel Characteristics Associated With Hard Outcomes After PCI and Their Combined Prognostic Implications |
| title_fullStr | Clinical and Vessel Characteristics Associated With Hard Outcomes After PCI and Their Combined Prognostic Implications |
| title_full_unstemmed | Clinical and Vessel Characteristics Associated With Hard Outcomes After PCI and Their Combined Prognostic Implications |
| title_short | Clinical and Vessel Characteristics Associated With Hard Outcomes After PCI and Their Combined Prognostic Implications |
| title_sort | clinical and vessel characteristics associated with hard outcomes after pci and their combined prognostic implications |
| topic | drug‐eluting stent fractional flow reserve risk stratification |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.030572 |
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