TY - JOUR
T1 - Utility of the ACC/AHA Lesion Classification to Predict Outcomes After Contemporary DES Treatment
T2 - Individual Patient Data Pooled Analysis From 7 Randomized Trials
AU - Konigstein, Maayan
AU - Redfors, Björn
AU - Zhang, Zixuan
AU - Kotinkaduwa, Lak N.
AU - Mintz, Gary S.
AU - Smits, Pieter C.
AU - Serruys, Patrick W.
AU - von Birgelen, Clemens
AU - Madhavan, Mahesh V.
AU - Golomb, Mordechai
AU - Ben-Yehuda, Ori
AU - Mehran, Roxana
AU - Leon, Martin B.
AU - Stone, Gregg W.
N1 - Funding Information:
Gary S. Mintz discloses honoraria from Boston Scientific and Philips. Pieter C. Smits discloses institutional research grants and speakers fees from Abbott
Publisher Copyright:
© 2022 The Authors.
PY - 2022/12/20
Y1 - 2022/12/20
N2 - BACKGROUND: Use of the modified American College of Cardiology (ACC)/American Heart Association (AHA) lesion classification as a prognostic tool to predict short-and long-term clinical outcomes after percutaneous coronary intervention in the modern drug-eluting stent era is uncertain. METHODS AND RESULTS: Patient-level data from 7 prospective, randomized trials were pooled. Clinical outcomes of patients undergoing single lesion percutaneous coronary intervention with second-generation drug-eluting stent were analyzed according to modified ACC/AHA lesion class. The primary end point was target lesion failure (TLF: composite of cardiac death, target vessel myocardial infarction, or ischemia-driven target lesion revascularization). Clinical outcomes to 5 years were compared between patients treated for noncomplex (class A/B1) versus complex (class B2/C) lesions. Eight thousand five hundred sixteen patients (age 63.1±10.8 years, 70.5% male) were analyzed. Lesions were classified as A, B1, B2, and C in 7.9%, 28.5%, 33.7%, and 30.0% of cases, respectively. Target lesion failure was higher in patients undergoing percutaneous coronary intervention of complex versus noncomplex lesions at 30 days (2.0% versus 1.1%, P=0.004), at 1 year (4.6% versus 3.0%, P=0.0005), and at 5 years (12.4% versus 9.2%, P=0.0001). By multivariable analysis, treatment of ACC/AHA class B2/C lesions was significantly associated with higher rate of 5-year target lesion failure (adjusted hazard ratio, 1.39 [95% CI, 1.17– 1.64], P=0.0001) driven by significantly higher rates of target vessel myocardial infarction and ischemia-driven target lesion revascularization. CONCLUSIONS: In this pooled large-scale analysis, treating complex compared with noncomplex lesions according to the modified ACC/AHA classification with second-generation drug-eluting stent was associated with worse 5-year clinical outcomes. This historical classification system may be useful in the contemporary era for predicting early and late outcomes following percutaneous coronary intervention.
AB - BACKGROUND: Use of the modified American College of Cardiology (ACC)/American Heart Association (AHA) lesion classification as a prognostic tool to predict short-and long-term clinical outcomes after percutaneous coronary intervention in the modern drug-eluting stent era is uncertain. METHODS AND RESULTS: Patient-level data from 7 prospective, randomized trials were pooled. Clinical outcomes of patients undergoing single lesion percutaneous coronary intervention with second-generation drug-eluting stent were analyzed according to modified ACC/AHA lesion class. The primary end point was target lesion failure (TLF: composite of cardiac death, target vessel myocardial infarction, or ischemia-driven target lesion revascularization). Clinical outcomes to 5 years were compared between patients treated for noncomplex (class A/B1) versus complex (class B2/C) lesions. Eight thousand five hundred sixteen patients (age 63.1±10.8 years, 70.5% male) were analyzed. Lesions were classified as A, B1, B2, and C in 7.9%, 28.5%, 33.7%, and 30.0% of cases, respectively. Target lesion failure was higher in patients undergoing percutaneous coronary intervention of complex versus noncomplex lesions at 30 days (2.0% versus 1.1%, P=0.004), at 1 year (4.6% versus 3.0%, P=0.0005), and at 5 years (12.4% versus 9.2%, P=0.0001). By multivariable analysis, treatment of ACC/AHA class B2/C lesions was significantly associated with higher rate of 5-year target lesion failure (adjusted hazard ratio, 1.39 [95% CI, 1.17– 1.64], P=0.0001) driven by significantly higher rates of target vessel myocardial infarction and ischemia-driven target lesion revascularization. CONCLUSIONS: In this pooled large-scale analysis, treating complex compared with noncomplex lesions according to the modified ACC/AHA classification with second-generation drug-eluting stent was associated with worse 5-year clinical outcomes. This historical classification system may be useful in the contemporary era for predicting early and late outcomes following percutaneous coronary intervention.
KW - drug-eluting stents
KW - percutaneous coronary intervention
KW - target lesion failure
UR - http://www.scopus.com/inward/record.url?scp=85144509855&partnerID=8YFLogxK
U2 - 10.1161/JAHA.121.025275
DO - 10.1161/JAHA.121.025275
M3 - Article
C2 - 36515253
AN - SCOPUS:85144509855
SN - 2047-9980
VL - 11
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 24
M1 - e025275
ER -
