Impact of PCI Appropriateness in the Long-Term Outcomes of Consecutive Patients Treated With Second-Generation Drug-Eluting Stents

• Published in: The Journal of invasive cardiology 2017-09, Vol.29 (9), p.290-296
• Main Authors: Seixas, Ana Cristina, Sousa, Amanda, de Ribamar Costa, Jr, Jose, Costa Moreira, Adriana, Costa, Ricardo, Damiani, Lucas, Campos Neto, Cantídio, Maldonado, Galo, Cano, Manuel, Sousa, J Eduardo
• Format: Article
• Language: English
• Subjects: Aged; Coronary Angiography; Coronary Artery Disease - diagnosis; Coronary Artery Disease - surgery; Drug-Eluting Stents; Female; Follow-Up Studies; Humans; Male; Middle Aged; Percutaneous Coronary Intervention - methods; Retrospective Studies; Time Factors; Treatment Outcome
• ISSN: 1557-2501

Appropriate use criteria (AUC) for coronary revascularization were developed to deliver high-quality care; however, the prognostic impact of these criteria remains unclear. We sought to assess the outcomes of patients treated with second-generation drug-eluting stent (DES) classified according to the updated American College of Cardiology Foundation/American Heart Association/Society for Cardiac Angiography and Intervention AUC for percutaneous coronary intervention (PCI). Between January 2012 and December 2013, a total of 1108 consecutive patients treated only with second-generation DES were categorized according to the AUC in three groups, using the new proposed terminology: appropriate ("A"); uncertain ("U"); and inappropriate ("I"). Major adverse cardiac event (MACE, defined as cardiac death, non-fatal myocardial infarction, and ischemia-driven target-lesion revascularization) and stent thrombosis up to 3 years were compared. PCI was categorized as A in 33.8%, U in 46.8%, and I in 19.4% of all cases. PCI-A patients had a higher prevalence of acute coronary syndromes, while PCI-I involved the treatment of more diabetics and patients with stable coronary disease. There were no differences in procedural complications among the three groups, with comparable rates of in-hospital MACE (9.3% for A vs 9.0% for U vs 7.0% for I; P=.70) and 2-year MACE (13.9% for A vs 9.0% for U vs 8.6% for I; P=.40). In the multivariable analysis, AUC classification was not associated with adverse outcomes. In this contemporary cohort of patients treated with second-generation DES implantation, AUC did not impact 3-year clinical follow-up.