TY - JOUR
T1 - Percutaneous coronary intervention in side branch coronary arteries
T2 - Insights from the Japanese nationwide registry
AU - Murasato, Yoshinobu
AU - Yamaji, Kyohei
AU - Kohsaka, Shun
AU - Wada, Hideki
AU - Ishii, Hideki
AU - Kinoshita, Yoshihisa
AU - Shite, Junya
AU - Hikichi, Yutaka
AU - Amano, Tetsuya
AU - Ikari, Yuji
N1 - Funding Information:
The Japanese PCI Registry is a prospective, Japanese, nationwide multicenter registry, designed to survey the clinical data of patients undergoing PCI [10–12] . The registry has been operated by the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) since 2007 [10–12] . Registration in the Japanese PCI database is mandatory for the application and renewal of board certification of the CVIT. The relevant committee and the Board of Directors of the CVIT approved the registry protocol for the collection of variables concerning each patient’s background, clinical presentation, angiographic and procedural information, and in-hospital outcomes. The CVIT also holds an annual meeting of data managers, and visits 20 randomly chosen participating institutions annually, to monitor the quality of submitted data. The protocol of the Japanese PCI Registry was approved by the Institutional Review Board Committee at the Network for Promotion of Clinical Studies in a specified non-profit organization affiliated with the Osaka University Graduate School of Medicine (CRPNJSOP-4–5). According to the annual reports of the Japanese Registry of All Cardiac and Vascular Disease, 278,285 PCIs were performed in 2018 ( http://www.j-circ.or.jp/jittai_chosa/jittai_chosa2017web.pdf ). As 257,492 PCIs were included in the Japanese PCI Registry in 2018, the registry is estimated to account for 93% of all PCI procedures in Japan. The CVIT drafted a research proposal using the Japanese PCI Registry in August 2019, and our proposal was adopted in December. This study was supported by the CVIT and was conducted in accordance with our research proposal. The requirement for obtaining written informed consent from the patients was waived, given the retrospective study design.
Publisher Copyright:
© 2021 The Author(s)
PY - 2021/10
Y1 - 2021/10
N2 - Background: Performance of percutaneous coronary intervention (PCI) in side-branch vessels (SB-PCI) has not been fully investigated despite the technical advancement of PCI. Methods: We investigated 257,492 patients registered in the Japanese nationwide PCI registry from January to December 2018; 199,767 (78%) underwent PCI for major vessel PCI (MV-PCI), 21,555 (8.4%) underwent SB-PCI, and 24,862 (9.6%) underwent PCI for both vessels (SB + MV-PCI). The frequencies of primary composite adverse events, defined as in-hospital mortality and procedural complications (i.e., peri-procedural myocardial infarction, tamponade, new-onset cardiogenic shock, stent thrombosis, emergent surgery, and bleeding), and PCI for restenotic lesions were investigated. Their association with institutional frequency of each PCI was also investigated. Results: Fewer drug-eluting stents (66% vs. 86%) and more drug-coated balloons (23% vs. 9%) were used in SB-PCI than in MV-PCI (p < 0.001). Pre-procedure non-invasive testing was similarly performed in SB-PCI and MV-PCI (57% vs. 61%). The composite endpoint was observed in 0.7%, 1.9%, and 2.2% of the SB-PCI, SB + MV-PCI, and MV-PCI groups, respectively (p < 0.001). Institutional frequency of SB-PCI was inversely associated with the composite-endpoint risk for all PCI procedures (odds ratio 1.37, 95% confidence interval 1.04–1.81 in the lowest tertile, with reference to the middle tertile, p = 0.02). Frequency of PCI for restenotic lesions was also inversely associated with the institutional frequency of MV-PCI (p < 0.001). Conclusion: SB-PCI was performed safely with a low frequency of acute complications, and higher SB-PCI frequency presented a lower risk of in-hospital adverse events, albeit with a cost of an increase in PCI for restenotic lesions.
AB - Background: Performance of percutaneous coronary intervention (PCI) in side-branch vessels (SB-PCI) has not been fully investigated despite the technical advancement of PCI. Methods: We investigated 257,492 patients registered in the Japanese nationwide PCI registry from January to December 2018; 199,767 (78%) underwent PCI for major vessel PCI (MV-PCI), 21,555 (8.4%) underwent SB-PCI, and 24,862 (9.6%) underwent PCI for both vessels (SB + MV-PCI). The frequencies of primary composite adverse events, defined as in-hospital mortality and procedural complications (i.e., peri-procedural myocardial infarction, tamponade, new-onset cardiogenic shock, stent thrombosis, emergent surgery, and bleeding), and PCI for restenotic lesions were investigated. Their association with institutional frequency of each PCI was also investigated. Results: Fewer drug-eluting stents (66% vs. 86%) and more drug-coated balloons (23% vs. 9%) were used in SB-PCI than in MV-PCI (p < 0.001). Pre-procedure non-invasive testing was similarly performed in SB-PCI and MV-PCI (57% vs. 61%). The composite endpoint was observed in 0.7%, 1.9%, and 2.2% of the SB-PCI, SB + MV-PCI, and MV-PCI groups, respectively (p < 0.001). Institutional frequency of SB-PCI was inversely associated with the composite-endpoint risk for all PCI procedures (odds ratio 1.37, 95% confidence interval 1.04–1.81 in the lowest tertile, with reference to the middle tertile, p = 0.02). Frequency of PCI for restenotic lesions was also inversely associated with the institutional frequency of MV-PCI (p < 0.001). Conclusion: SB-PCI was performed safely with a low frequency of acute complications, and higher SB-PCI frequency presented a lower risk of in-hospital adverse events, albeit with a cost of an increase in PCI for restenotic lesions.
KW - Complications
KW - Coronary artery disease
KW - Percutaneous coronary intervention
KW - Side branch
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U2 - 10.1016/j.ijcha.2021.100856
DO - 10.1016/j.ijcha.2021.100856
M3 - Article
AN - SCOPUS:85112382641
SN - 2352-9067
VL - 36
JO - IJC Heart and Vasculature
JF - IJC Heart and Vasculature
M1 - 100856
ER -