Complex target lesion anatomy linked to increased ischemic events
Complex target lesion anatomy stenting is associated with increased ischemic event rates in patients undergoing PCI, especially within the first year, according to new data.
“Among patients enrolled and randomized in the DAPT study, we found that those undergoing PCI with more complex coronary artery target lesions had a higher rate of subsequent ischemic events, particularly within the first year after PCI compared with patients without complex lesions,” Robert W. Yeh, MD, MSc, from the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology at Beth Israel Deaconess Medical Center, and colleagues wrote. “After the first year, this association was attenuated.”
Researchers evaluated 25,416 randomly assigned patients from the double-blind, randomized, placebo-controlled DAPT study to assess the effect of 30 months vs. 12 months of dual antiplatelet therapy after PCI to determine differences in outcomes based on presence or absence of anatomically complex target lesions.
Patients with more complex target lesions had higher rates of MI or stent thrombosis in the first 12 months after PCI (3.9% vs. 2.4%; P < .001), according to the researchers.
In patients who were event-free at 12 months, MI or stent thrombosis rates between 12 and 30 months were similar between those with and those without complex anatomy (3.5% vs. 2.9%; P = .07).
Reduced rates of MI or stent thrombosis with continued thienopyridine vs. placebo after 12 months was similar for those with anatomic complexity (2.5% vs. 4.5%; HR = 0.55; 95% CI, 0.38-0.79) and without it (2% vs. 3.8%; HR = 0.52; 95% CI, 0.39-0.69; P for interaction = .81). The increase in moderate/severe bleeding associated with continued thienopyridine was also similar in both groups (P for interaction = .44), Yeh and colleagues wrote.
Among patients with anatomic complexity, those with DAPT scores of 2 or lower who were randomly assigned to continued thienopyridine had reductions in MI or stent thrombosis (3% vs. 6.1%; P < .001) compared with those who had scores greater than 2 (1.7% vs. 2.3%; P = .42; P for risk differences = .03).
A related editorial from Antonio Colombo, MD, and Francesco Giannini, MD, from the unit of cardiovascular interventions, IRCCS San Raffaele Scientific institute in Milan, stated that lesion complexity may not affect the benefits of DAPT duration because of a need to protect the entire coronary tree as opposed to the stented or treated segments.
“This need is better expressed by patient-related factors, whereas lesion complexity remains an indirect marker of disease burden,” they wrote. “The power of lesion complexity to be a marker for disease burden depends upon the definition of a complex lesion.” by Dave Quaile
Disclosures: Yeh reports he has received funding from Abiomed and Boston Scientific and is a consultant for Abbott Vascular and Boston Scientific. Colombo and Giannini report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.