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. 2022 Jun 24:9:913588.
doi: 10.3389/fcvm.2022.913588. eCollection 2022.

Temporal Trends in Complex Percutaneous Coronary Interventions

Mark Kheifets  1   2 , Shelly Abigail Vons  1   2 , Tamir Bental  1   2 , Hana Vaknin-Assa  1   2 , Gabriel Greenberg  1   2 , Abed Samara  1   2 , Pablo Codner  1   2 , Guy Wittberg  1   2 , Yeela Talmor Barkan  1   2 , Leor Perl  1   2 , Ran Kornowski  1   2 , Amos Levi  1   2
Affiliations

Temporal Trends in Complex Percutaneous Coronary Interventions

Mark Kheifets et al. Front Cardiovasc Med. .

Abstract

Background: Accumulated experience combined with technological advancements in percutaneous coronary interventions (PCI) over the past four decades, has led to a gradual increase in PCI utilization and complexity. We aimed to investigate the temporal trends in PCI complexity and the outcomes of complex PCI (C-PCI) in our institution.

Methods: We analyzed 20,301 consecutive PCI procedures performed over a 12-year period. C-PCI was defined as a procedure involving at least one of the following: Chronic total occlusion (CTO), left main (LM), bifurcation or saphenous vein graft (SVG) PCI. Four periods of 3-year time intervals were defined (2008-10, 2011-2013, 2014-2016, 2017-2019), and temporal trends in the rate and outcomes of C-PCI within these intervals were studied. Endpoints included mortality and major adverse cardiac events [MACE: death, acute myocardial infarction (MI), and target vessel revascularization (TVR)] at 1 year.

Results: A total of 5,647 (27.8%) C-PCI procedures were performed. The rate of C-PCI has risen significantly since 2,017 (31.2%, p < 0.01), driven mainly by bifurcation and LM interventions (p < 0.01). At 1-year, rates of death, acute MI, TVR and MACE, were all significantly higher in the C-PCI group (8.8 vs. 5.1%, 5.6 vs. 4.5%, 5.5 vs. 4.0%, 17.2 vs. 12.2%, p < 0.001 for all, respectively), as compared to the non-complex group. C-PCI preformed in the latter half of the study period (2014-2019) were associated with improved 1-year TVR (4.4% and 4.8% vs. 6.7% and 7.1%, p = 0.01, respectively) and MACE (13.8% and 13.5% vs. 17.3% and 18.2%, p = 0.001, respectively) rates compared to the earlier period (2007-2013). Death rate had not significantly declined with time.

Conclusion: In the current cohort, we have detected a temporal increase in PCI complexity coupled with improved 1-year clinical outcomes in C-PCI.

Keywords: CTO (chronic total occlusion); PCI—percutaneous coronary intervention; SVG = saphenous vein graft; bifurcation; complexity; left main; trends.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Rate of complex PCI (percent of total interventions) per time period.
FIGURE 2
FIGURE 2
Interventions grouped by time period and complexity definition.
FIGURE 3
FIGURE 3
Complex vs. non-complex (death).
FIGURE 4
FIGURE 4
Complex vs. non-complex (MACE).
FIGURE 5
FIGURE 5
Complex vs. non-complex (per time period MACE).
FIGURE 6
FIGURE 6
Complex vs. non-complex (per time period death).
FIGURE 7
FIGURE 7
Cumulative incidence of TVR at 1 year, grouped by time period.
FIGURE 8
FIGURE 8
Cumulative incidence of acute-MI at 1 year, grouped by time period.
See this image and copyright information in PMC

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