Residual ischemic disease after PCI tied to worse outcomes: JACC
USA: Residual ischemic disease following PCI (percutaneous coronary intervention) is linked with a significantly greater risk of MACE (major adverse cardiovascular events) compared with complete revascularization, says a recent study published in JACC: Cardiovascular Interventions.
The study showed that patients with the most residual ischemic disease (based on the VA SYNTAX score calculated after the procedure) had a more than twofold higher risk of myocardial infarction, death, stroke, and repeat revascularization at 1 and 3 years, as well as a higher risk of MI and death, compared with those who were wholly revascularized.
Anatomical scoring systems have been used to evaluate the completeness of revascularization, but their use in large real-world datasets is challenging. Christopher P. Kovach from the University of Colorado in Aurora, Colorado, USA, and colleagues aimed to examine the prevalence of complete revascularization and its link with longitudinal clinical outcomes in the U.S. Department of Veterans Affairs (VA) health care system. For this purpose, they used an automatically computed anatomic complexity score. They validated the importance of complete revascularization for lowering the risk of future clinical events.
The team identified patients undergoing PCI between 2007 to 2020, and post-revascularization and pre-revascularization burden was quantified using the VA SYNTAX score. They also assessed the association between residual VA SYNTAX score and long-term MACE (repeat revascularization, death, stroke, and myocardial infarction). The VA SYNTAX score is an automatically calculated coronary anatomical complexity score adapted from the original SYNTAX score.
The authors reported the following findings:
- During the study period, a total of 57,476 veterans underwent PCI.
- The highest tertile of residual VA SYNTAX score after adjustment was associated with an increased hazard of MACE (HR: 2.06) and death (HR: 1.50) at three years compared to complete revascularization (residual VA SYNTAX score = 0).
- The hazard of 1- and 3-year MACE increased as a function of residual disease, notwithstanding baseline disease severity or initial presentation with the acute or chronic coronary syndrome.
The study showed a strong association between residual ischemic disease and long-term clinical outcomes in a contemporary national cohort of PCI patients.
"Automatically computed anatomic complexity scores can be used to evaluate the longitudinal risk for the residual ischemic disease after PCI and may be implemented to improve interventional quality," the researchers suggested.
Reference:
Kovach CP, Hebbe A, Glorioso TJ, Barrett C, Barón AE, Mavromatis K, Valle JA, Waldo SW. Association of Residual Ischemic Disease With Clinical Outcomes After Percutaneous Coronary Intervention. JACC Cardiovasc Interv. 2022 Dec 26;15(24):2475-2486. doi: 10.1016/j.jcin.2022.11.002. PMID: 36543441.
