Cargando…
Clinical Outcomes and Prognostic Factors in Complex, High-Risk Indicated Procedure (CHIP) and High-Bleeding-Risk (HBR) Patients Undergoing Percutaneous Coronary Intervention with Sirolimus-Eluting Stent Implantation: 4-Year Results
We aimed to characterize the performance and safety of percutaneous coronary intervention (PCI) in complex, high-risk indicated procedure (CHIP) and high-bleeding-risk (HBR) patients at a 4-year follow up. We included all consecutive patients who underwent PCI with the sirolimus-eluting coronary ste...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10455238/ https://www.ncbi.nlm.nih.gov/pubmed/37629356 http://dx.doi.org/10.3390/jcm12165313 |
_version_ | 1785096404570472448 |
---|---|
author | Tyczyński, Maciej Kern, Adam Buller, Patryk Wańha, Wojciech Gil, Robert J. Bil, Jacek |
author_facet | Tyczyński, Maciej Kern, Adam Buller, Patryk Wańha, Wojciech Gil, Robert J. Bil, Jacek |
author_sort | Tyczyński, Maciej |
collection | PubMed |
description | We aimed to characterize the performance and safety of percutaneous coronary intervention (PCI) in complex, high-risk indicated procedure (CHIP) and high-bleeding-risk (HBR) patients at a 4-year follow up. We included all consecutive patients who underwent PCI with the sirolimus-eluting coronary stent Alex Plus (Balton, Poland) between July 2015 and March 2016. We analyzed various baseline demographic and clinical characteristics, laboratory data, and clinical outcomes. We enrolled 232 patients in whom 282 stents were implanted, including 81 patients meeting the CHIP criteria and 76 patients meeting the HBR criteria. In the whole population, the mean age was 68 ± 11 years, and 23.7% were females. Most procedures were performed from radial access (83.2%) using a 6F guiding catheter (95.7%). The lesions were mostly predilated (61.6%), and postdilatation was performed in 37.9%. The device success was 99.6% (in one case, a second stent was required due to heavy calcifications). Additional stents were deployed in 39% of cases due to edge dissection (6.9%), side branch stenting (5.2%), or diffuse disease (26.9%). Myocardial infarction (MI) type 4a was revealed in 2.2% of cases. At 4 years, the MACE rates for the whole population and for CHIP and HBR patients were 23.3%, 29.6%, and 27.6%, respectively. CHIP patients had a higher risk of MACEs (29.6% vs. 19.9%, HR 1.69, p = 0.032) and cardiac death (11.1% vs. 4.6%, HR 2.50, p = 0.048). There were no differences for MI (7.4% vs. 6.6%, p = 0.826) and TLR (18.5% vs. 12.6%, p = 0.150). HBR patients were also characterized by a higher risk of MACEs (27.6% vs. 21.2%, HR 1.84, p = 0.049) and cardiac death (17.1% vs. 1.9%, HR 9.61, p < 0.001). There were no differences for MI (7.9% vs. 6.4%, p = 0.669) and TLR (11.8% vs. 16.0%, p = 0.991). PCI in CHIP and HBR patients is feasible with a low rate of periprocedural complications. Nevertheless, CHIP and HBR patients are at a high risk of future adverse events and require strict surveillance to improve outcomes. |
format | Online Article Text |
id | pubmed-10455238 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-104552382023-08-26 Clinical Outcomes and Prognostic Factors in Complex, High-Risk Indicated Procedure (CHIP) and High-Bleeding-Risk (HBR) Patients Undergoing Percutaneous Coronary Intervention with Sirolimus-Eluting Stent Implantation: 4-Year Results Tyczyński, Maciej Kern, Adam Buller, Patryk Wańha, Wojciech Gil, Robert J. Bil, Jacek J Clin Med Article We aimed to characterize the performance and safety of percutaneous coronary intervention (PCI) in complex, high-risk indicated procedure (CHIP) and high-bleeding-risk (HBR) patients at a 4-year follow up. We included all consecutive patients who underwent PCI with the sirolimus-eluting coronary stent Alex Plus (Balton, Poland) between July 2015 and March 2016. We analyzed various baseline demographic and clinical characteristics, laboratory data, and clinical outcomes. We enrolled 232 patients in whom 282 stents were implanted, including 81 patients meeting the CHIP criteria and 76 patients meeting the HBR criteria. In the whole population, the mean age was 68 ± 11 years, and 23.7% were females. Most procedures were performed from radial access (83.2%) using a 6F guiding catheter (95.7%). The lesions were mostly predilated (61.6%), and postdilatation was performed in 37.9%. The device success was 99.6% (in one case, a second stent was required due to heavy calcifications). Additional stents were deployed in 39% of cases due to edge dissection (6.9%), side branch stenting (5.2%), or diffuse disease (26.9%). Myocardial infarction (MI) type 4a was revealed in 2.2% of cases. At 4 years, the MACE rates for the whole population and for CHIP and HBR patients were 23.3%, 29.6%, and 27.6%, respectively. CHIP patients had a higher risk of MACEs (29.6% vs. 19.9%, HR 1.69, p = 0.032) and cardiac death (11.1% vs. 4.6%, HR 2.50, p = 0.048). There were no differences for MI (7.4% vs. 6.6%, p = 0.826) and TLR (18.5% vs. 12.6%, p = 0.150). HBR patients were also characterized by a higher risk of MACEs (27.6% vs. 21.2%, HR 1.84, p = 0.049) and cardiac death (17.1% vs. 1.9%, HR 9.61, p < 0.001). There were no differences for MI (7.9% vs. 6.4%, p = 0.669) and TLR (11.8% vs. 16.0%, p = 0.991). PCI in CHIP and HBR patients is feasible with a low rate of periprocedural complications. Nevertheless, CHIP and HBR patients are at a high risk of future adverse events and require strict surveillance to improve outcomes. MDPI 2023-08-15 /pmc/articles/PMC10455238/ /pubmed/37629356 http://dx.doi.org/10.3390/jcm12165313 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Tyczyński, Maciej Kern, Adam Buller, Patryk Wańha, Wojciech Gil, Robert J. Bil, Jacek Clinical Outcomes and Prognostic Factors in Complex, High-Risk Indicated Procedure (CHIP) and High-Bleeding-Risk (HBR) Patients Undergoing Percutaneous Coronary Intervention with Sirolimus-Eluting Stent Implantation: 4-Year Results |
title | Clinical Outcomes and Prognostic Factors in Complex, High-Risk Indicated Procedure (CHIP) and High-Bleeding-Risk (HBR) Patients Undergoing Percutaneous Coronary Intervention with Sirolimus-Eluting Stent Implantation: 4-Year Results |
title_full | Clinical Outcomes and Prognostic Factors in Complex, High-Risk Indicated Procedure (CHIP) and High-Bleeding-Risk (HBR) Patients Undergoing Percutaneous Coronary Intervention with Sirolimus-Eluting Stent Implantation: 4-Year Results |
title_fullStr | Clinical Outcomes and Prognostic Factors in Complex, High-Risk Indicated Procedure (CHIP) and High-Bleeding-Risk (HBR) Patients Undergoing Percutaneous Coronary Intervention with Sirolimus-Eluting Stent Implantation: 4-Year Results |
title_full_unstemmed | Clinical Outcomes and Prognostic Factors in Complex, High-Risk Indicated Procedure (CHIP) and High-Bleeding-Risk (HBR) Patients Undergoing Percutaneous Coronary Intervention with Sirolimus-Eluting Stent Implantation: 4-Year Results |
title_short | Clinical Outcomes and Prognostic Factors in Complex, High-Risk Indicated Procedure (CHIP) and High-Bleeding-Risk (HBR) Patients Undergoing Percutaneous Coronary Intervention with Sirolimus-Eluting Stent Implantation: 4-Year Results |
title_sort | clinical outcomes and prognostic factors in complex, high-risk indicated procedure (chip) and high-bleeding-risk (hbr) patients undergoing percutaneous coronary intervention with sirolimus-eluting stent implantation: 4-year results |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10455238/ https://www.ncbi.nlm.nih.gov/pubmed/37629356 http://dx.doi.org/10.3390/jcm12165313 |
work_keys_str_mv | AT tyczynskimaciej clinicaloutcomesandprognosticfactorsincomplexhighriskindicatedprocedurechipandhighbleedingriskhbrpatientsundergoingpercutaneouscoronaryinterventionwithsirolimuselutingstentimplantation4yearresults AT kernadam clinicaloutcomesandprognosticfactorsincomplexhighriskindicatedprocedurechipandhighbleedingriskhbrpatientsundergoingpercutaneouscoronaryinterventionwithsirolimuselutingstentimplantation4yearresults AT bullerpatryk clinicaloutcomesandprognosticfactorsincomplexhighriskindicatedprocedurechipandhighbleedingriskhbrpatientsundergoingpercutaneouscoronaryinterventionwithsirolimuselutingstentimplantation4yearresults AT wanhawojciech clinicaloutcomesandprognosticfactorsincomplexhighriskindicatedprocedurechipandhighbleedingriskhbrpatientsundergoingpercutaneouscoronaryinterventionwithsirolimuselutingstentimplantation4yearresults AT gilrobertj clinicaloutcomesandprognosticfactorsincomplexhighriskindicatedprocedurechipandhighbleedingriskhbrpatientsundergoingpercutaneouscoronaryinterventionwithsirolimuselutingstentimplantation4yearresults AT biljacek clinicaloutcomesandprognosticfactorsincomplexhighriskindicatedprocedurechipandhighbleedingriskhbrpatientsundergoingpercutaneouscoronaryinterventionwithsirolimuselutingstentimplantation4yearresults |