Independent Clinical Impacts of Procedural Complexity on Ischemic and Bleeding Events in Patients with Acute Myocardial Infarction: Long-Term Clinical Study.
Kwan Yong LeeByung-Hee HwangSung Min LimChan Jun KimEun-Ho ChooSeung Hoon LeeJin-Jin KimIk-Jun ChoiGyu-Chul OhIn-Ho YangKi-Dong YooWook Sung ChungYoungkeun AhnMyung Ho JeongKiyuk ChangPublished in: Journal of clinical medicine (2022)
This study aimed to investigate the relationship between a complex percutaneous coronary intervention (C-PCI) and long-term clinical outcomes in the AMI cohort. A total of 10,329 patients were categorized into the C-PCI and non-C-PCI groups. The primary ischemic endpoint was a composite of major adverse cardiac events (MACEs, cardiac death, myocardial infarction, stent thrombosis and revascularization). The primary bleeding endpoint was the risk of overt bleeding (BARC 2, 3 or 5). The median follow-up duration was 4.9 (2.97, 7.16) years. The risks of MACEs and bleeding were significantly higher in the C-PCI group (hazard ratio (HR): 1.72; 95% confidence interval (CI): 1.60 to 1.85; p < 0.001; and HR: 1.32; 95% CI: 1.17 to 1.50; p < 0.001, respectively). After propensity score matching, compared to the non-C-PCI group, the adjusted MACE rate in C-PCI remained significantly higher ( p < 0.001), but no significant interaction ( p = 0.273) was observed for bleeding. Significant differences in overt bleeding were observed only within the first three months ( p = 0.024). The MACEs were consistently higher in the C-PCI group with or without severe comorbid conditions ( p < 0.001 for both). Patients with AMI who undergo C-PCI experience worse long-term ischemic outcomes after successful PCI, regardless of the presence of severe comorbidities.
Keyphrases
- acute myocardial infarction
- percutaneous coronary intervention
- atrial fibrillation
- st segment elevation myocardial infarction
- coronary artery disease
- antiplatelet therapy
- acute coronary syndrome
- st elevation myocardial infarction
- coronary artery bypass grafting
- left ventricular
- coronary artery bypass
- brain injury
- emergency department
- pulmonary embolism
- blood brain barrier
- end stage renal disease
- oxidative stress
- ejection fraction
- prognostic factors
- peritoneal dialysis
- patient reported
- human health
- patient reported outcomes