Author + information
- Received January 1, 2018
- Revision received January 25, 2018
- Accepted January 31, 2018
- Published online May 2, 2018.
- Tullio Palmerini, MDa,
- Diego Della Riva, MDa,
- Giuseppe Biondi-Zoccai, MD, MStatb,c,
- Martin B. Leon, MDd,e,
- Patrick W. Serruys, MD, PhDf,
- Pieter C. Smits, MDg,
- Clemens von Birgelen, MD, PhDh,
- Ori Ben-Yehuda, MDd,e,
- Philippe Généreux, MDe,i,j,
- Antonio G. Bruno, MDa,
- Paul Jenkins, PhDe and
- Gregg W. Stone, MDd,e,∗ ()
- aPolo Cardio-Toraco-Vascolare, Policlinico S. Orsola, Bologna, Italy
- bDepartment of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- cDepartment of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
- dNewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
- eClinical Trials Center, Cardiovascular Research Foundation, New York, New York
- fInternational Centre for Circulatory Health, NHLI, Imperial College London, London, United Kingdom
- gDepartment of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands
- hDepartment of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, University of Twente, Enschede, the Netherlands
- iGagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey
- jHôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
- ↵∗Address for correspondence:
Dr. Gregg W. Stone, Columbia University Medical Center, Cardiovascular Research Foundation, 1700 Broadway, 8th Floor, New York, New York 10019.
Objectives This study sought to investigate the impact of nonemergent, uncomplicated target lesion revascularization (TLR) on the risk of long-term mortality after percutaneous coronary intervention (PCI).
Background Restenosis requiring TLR after PCI is generally considered a benign event.
Methods The study pooled patient-level data from 21 randomized trials. Subjects dying the same day as or the day after the TLR procedure as well as those with myocardial infarction (MI) the day before, the same day as or the day after TLR were excluded. The primary endpoint of the study was all-cause mortality.
Results The dataset included 32,524 patients who were stratified according to whether repeat TLR was performed during follow-up. During a median follow-up of 37 months, 2,330 (7.2%) patients underwent a nonemergent, uncomplicated TLR procedure. After adjusting for potential confounders, TLR was an independent predictor of mortality (hazard ratio: 1.23, 95% confidence interval: 1.04 to 1.45; p = 0.02). Patients undergoing nonemergent, uncomplicated TLR had significantly higher rates of non–procedure-related MI compared with those without TVR. Among patients undergoing elective TLR, MI occurring after TLR was an independent predictor of mortality (hazard ratio: 3.82; 95% confidence interval: 2.44 to 5.99; p < 0.0001).
Conclusions Nonemergent, uncomplicated TLR after PCI is an independent predictor of long-term mortality, an association in part explained by higher rates of MI occurring after TLR. Efforts aimed at reducing TLR risk may translate into prognostic benefits including reduced rates of MI and survival.
Dr. Palmerini has received speaker fees from Abbott Vascular; and grant support from Eli Lilly. Dr. Biondi-Zoccai has received consulting honoraria from Abbott Vascular and Bayer. Dr. Serruys has received personal fees from Abbott Laboratories, AstraZeneca, Biotrinik, Cardialysis, GLG Research, Medtronic, Sino Medical Sciences Technology, Société Europa Digital Publishing, Stentys France, Svelte Medical Systems, Philips/Volcano, St. Jude Medical, Qualimed, and Xeltis, outside the submitted work. Dr. Smits has received grant support and speaker fees from Abbott Vascular, Terumo, and St. Jude Medical. Dr. von Birgelen has received institutional research grants from AstraZeneca, Biotronik, Boston Scientific, and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 1, 2018.
- Revision received January 25, 2018.
- Accepted January 31, 2018.
- 2018 American College of Cardiology Foundation