Association of Residual Ischemic Disease With Clinical Outcomes After Percutaneous Coronary Intervention

• Published in: JACC. Cardiovascular interventions 2022-12, Vol.15 (24), p.2475-2486
• Main Authors: Kovach, Christopher P., Hebbe, Annika, Glorioso, Thomas J., Barrett, Christopher, Barón, Anna E., Mavromatis, Kreton, Valle, Javier A., Waldo, Stephen W.
• Format: Article
• Language: English
• Subjects: anatomical complexity score; Cardiac Surgical Procedures; Coronary Angiography; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - etiology; Coronary Artery Disease - therapy; Heart; Humans; mortality; Myocardial Infarction - etiology; outcomes; percutaneous coronary intervention; Percutaneous Coronary Intervention - adverse effects; quality; residual ischemic disease; Risk Assessment; Risk Factors; Treatment Outcome
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2022.11.002

Anatomical scoring systems have been used to assess completeness of revascularization but are challenging to apply to large real-world datasets. The aim of this study was to assess the prevalence of complete revascularization and its association with longitudinal clinical outcomes in the U.S. Department of Veterans Affairs (VA) health care system using an automatically computed anatomic complexity score. Patients undergoing percutaneous coronary intervention (PCI) between October 1, 2007, and September 30, 2020, were identified, and the burden of prerevascularization and postrevascularization ischemic disease was quantified using the VA SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score. The association between residual VA SYNTAX score and long-term major adverse cardiovascular events (MACE; death, myocardial infarction, repeat revascularization, and stroke) was assessed. A total of 57,476 veterans underwent PCI during the study period. After adjustment, the highest tertile of residual VA SYNTAX score was associated with increased hazard of MACE (HR: 2.06; 95% CI: 1.98-2.15) and death (HR: 1.50; 95% CI: 1.41-1.59) at 3 years compared to complete revascularization (residual VA SYNTAX score = 0). Hazard of 1- and 3-year MACE increased as a function of residual disease, regardless of baseline disease severity or initial presentation with acute or chronic coronary syndrome. Residual ischemic disease was strongly associated with long-term clinical outcomes in a contemporary national cohort of PCI patients. Automatically computed anatomic complexity scores can be used to assess the longitudinal risk for residual ischemic disease after PCI and may be implemented to improve interventional quality. [Display omitted]