Predictors of outcomes after PCI with incomplete revascularization: Impact of CTO and LAD vessel

Abstract

AbstractBackgroundIncomplete revascularization (ICR) after percutaneous coronary intervention (PCI) is associated with mortality and morbidity.AimWe sought to investigate whether ICR in the left anterior descending artery (LAD) is worse than ICR of the right coronary artery (RCA) or left circumflex artery (LCX); and whether ICR in patients with a chronic total occlusion (CTO) is worse than in those without.MethodsIn the RIVER‐PCI trial, 2651 patients with ICR after PCI were randomly assigned to ranolazine or placebo. Angiograms were assessed at an independent core laboratory in 2501 patients (94.3%). The primary endpoint was the composite of ischemia‐driven revascularization or hospitalization.ResultsA total of 1664 patients (66.5%) had ICR involving the LAD, whereas 837 (33.5%) had ICR limited to the RCA or LCX. At median follow‐up of 643 days, the primary endpoint occurred in 26.9% versus 26.5% of patients (adjusted HR [aHR]: 1.03, 95% confidence interval [CI]: 0.88–1.21). A nonrecanalized CTO was present in 854 patients (34.1%) with ICR after PCI. The primary endpoint occurred in 28.6% versus 25.9% of ICR patients with versus without a CTO (aHR: 1.10, 95% CI: 0.94–1.29). However, patients with a CTO had higher rates of ischemia‐driven hospitalization without revascularization (aHR: 1.27, 95% CI: 1.04–1.56), heart failure hospitalization (aHR: 2.69, 95% CI: 1.61–4.59) and myocardial infarction (aHR: 1.46, 95% CI: 1.11–1.92) compared with those without.ConclusionsThe 2‐year prognosis was similar in post‐PCI patients with ICR whether the LAD was versus was not involved. ICR patients with a CTO had more frequent hospitalizations for ischemia and myocardial infarctions compared with those without.