Keele Research Repository

Aims: The present study sought to examine the prevalence, clinical characteristics and 1-year outcomes of patients undergoing percutaneous coronary intervention (PCI) to complex lesions (multivessel PCI, ≥3 stents, ≥3 lesions, bifurcation with ≥2 stents, total stent length> 60mm or
chronic total occlusion (CTO)) in a prospective multicentre registry. Methods and Results: Using the e-Ultimaster multicentre registry, a post-hoc sub-group analysis was performed on 35,839 patients undergoing PCI, stratified by procedure complexity, and further by number and type of complex features. Overall, complex PCI patients (n=9,793,
27.3%) were older, more comorbid and were associated with an increased hazard ratio (HR) of composite endpoint at 1-year (target lesion failure (TLF): 1.41 [1.25; 1.59]), driven by increased hazard of cardiac death (1.28 [1.05; 1.55]), target vessel myocardial infarction (1.48 [1.18; 1.86]) and clinically driven target lesion revascularisation. The hazard of complications increased with rising number of complex features (3-6 vs. 1-2 vs. none) for all outcomes. All individual complex features were associated with an increased hazard of composite complications (except CTO) and definite/probable stent thrombosis. Conclusions: Overall, complex PCI is associated with an increased risk of mortality and complications at 1-year. The number and types of complex features have differing impacts on long-term outcomes.