Does post-dilatation during angiography-guided percutaneous coronary intervention improve clinical outcomes? – results of systematical patient outcome monitoring,Hellenic Journal of Cardiology

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Does post-dilatation during angiography-guided percutaneous coronary intervention improve clinical outcomes? – results of systematical patient outcome monitoring
Hellenic Journal of Cardiology ( IF 4.1 ) Pub Date : 2023-11-16 , DOI: 10.1016/j.hjc.2023.11.004
Stacey R Slingerland ₁ , Konrad A J van Beek ₁ , Daniela N Schulz ₁ , Gijs J van Steenbergen ₁ , Tim Brouwer ₁ , Martin Stoel ₂ , Pieter-Jan Vlaar ₁ , Pim A Tonino ₁ , Lukas Dekker ₁ , Lokien X van Nunen ₃ , Koen Teeuwen ₁ , Dennis van Veghel ₁

Affiliation

Objectives

This study evaluates clinical outcomes after implementing a liberal post-dilatation strategy during PCI.

Background

Post-dilatation after percutaneous coronary intervention (PCI) is performed to achieve optimal stent expansion and reduce complications. However, its prognostic effects are unclear and conflicting.

Methods

This study is a pre-post intervention analysis of two cohorts, before (2015-2017) and after (2018-2020) implementation of a liberal post-dilatation strategy. The primary endpoint consisted of major adverse cardiovascular events (MACE) at 30-days. Secondary endpoints consisted of the individual components of the primary endpoint as well as 1 year mortality and target vessel revascularization.

Results

A total of 10,153 patients were included; 5,383 in the pre-cohort and 4,770 in the post-cohort. The 30-day MACE was 5.00% in the pre-cohort and 4.09% in the post-cohort (p=0.008; OR 0.75 (CI 0.61-0.93)). There was a significant difference between the pre- and post-cohort in 30-day mortality, respectively 2.91% and 2.25% (p=.01; OR 0.70 (CI 0.53-0.93)), and MI at 30 days, 1.17% versus 0.59% (p=.003; OR 0.49 (CI 0.31-0.78)). At 1 year, there was a significant difference in mortality between the pre-cohort, 5.84%, and post-cohort, 5.19% (p=.02; OR 0.79 (CI 0.66-0.96)).

Conclusions

A liberal post-dilatation strategy after PCI was associated with a significant decrease in 30-day MACE, 30-day MI, 30-day mortality and 1-year mortality. Future studies are warranted to validate the causality between post-dilatation and improvement of clinical outcomes.

中文翻译：

血管造影引导下的经皮冠状动脉介入治疗期间的后扩张是否可以改善临床结果？– 系统性患者结果监测的结果

目标

本研究评估 PCI 期间实施自由后扩张策略后的临床结果。

背景

经皮冠状动脉介入治疗 (PCI) 后进行后扩张，以实现最佳支架扩张并减少并发症。然而，其预后影响尚不清楚且相互矛盾。

方法

本研究是对实施自由后扩张策略之前（2015-2017 年）和实施后（2018-2020 年）两个队列的干预前分析。主要终点包括 30 天的主要不良心血管事件 (MACE)。次要终点包括主要终点的各个组成部分以及 1 年死亡率和靶血管血运重建。

结果

总共纳入了 10,153 名患者；前队列中有 5,383 人，后队列有 4,770 人。前队列中 30 天的 MACE 为 5.00%，后队列中为 4.09%（p = 0.008；OR 0.75 (CI 0.61-0.93)）。队列前和队列后 30 天死亡率存在显着差异，分别为 2.91% 和 2.25%（p = 0.01；OR 0.70 (CI 0.53-0.93)），30 天 MI 为 1.17% 与0.59%（p =0.003；OR 0.49（CI 0.31-0.78））。1 年时，队列前死亡率为 5.84%，队列后死亡率为 5.19%（p = 0.02；OR 0.79 (CI 0.66-0.96)）。