Accuracy of the PARIS score and PCI complexity to predict ischemic events in patients treated with very thin stents in unprotected left main or coronary bifurcations
Guglielmo Gallone
(1)
,
Fabrizio d'Ascenzo
(1)
,
Federico Conrotto
(1)
,
Francesco Costa
(2)
,
Davide Capodanno
(3)
,
Saverio Muscoli
(4)
,
Alaide Chieffo
(5)
,
Imori Yoichi
(6)
,
Mauro Pennacchi
(7)
,
Giorgio Quadri
(8)
,
Ivan Nuñez-Gil
(9, 10)
,
Pier Paolo Bocchino
(1)
,
Francesco Piroli
(1)
,
Ovidio de Filippo
(1)
,
Cristina Rolfo
(8)
,
Wojciech Wojakowski
(11)
,
Daniela Trabattoni
(5)
,
Zenon Huczek
(12)
,
Giuseppe Venuti
(3)
,
Andrea Montabone
(13)
,
Andrea Rognoni
(14)
,
Radoslaw Parma
(11)
,
Filippo Figini
(15)
,
Satoru Mitomo
(5)
,
Giacomo Boccuzzi
(13)
,
Alessio Mattesini
(16)
,
Enrico Cerrato
(8)
,
Wojciech Wańha
(11)
,
Grzegorz Smolka
(11)
,
Bernardo Cortese
(17)
,
Nicola Ryan
(9)
,
Mario Bo
(1)
,
Carlo Mario
(16)
,
Ferdinando Varbella
(8)
,
Francesco Burzotta
(18)
,
Imad Sheiban
(15)
,
Javier Escaned
(9, 10)
,
Gerard Helft
(19)
,
Gaetano Maria de Ferrari
(1)
1
UNITO -
Università degli studi di Torino = University of Turin
2 UniMe - Università degli Studi di Messina = University of Messina
3 Unict - Università degli studi di Catania = University of Catania
4 University of Rome "Tor Vergeta"
5 IRCCS Ospedale San Raffaele [Milan, Italy]
6 Nippon Medical School [Tokyo, Japon]
7 UNIROMA - Università degli Studi di Roma "La Sapienza" = Sapienza University [Rome]
8 OR - Ospedale di Rivoli [Rivoli, Italy]
9 IdISSC - Instituto de Investigación Sanitaria del Hospital Clínico San Carlos [Madrid, Spain]
10 UCM - Universidad Complutense de Madrid = Complutense University of Madrid [Madrid]
11 SUM - Medical University of Silesia
12 Medical University of Warsaw - Poland
13 OSGB - Ospedale San Giovanni Bosco [Turin, Italy]
14 University Hospital “Maggiore della Carità” [Novara, Italy]
15 CP - Clinica Pederzoli [Peschiera del Garda, Italy]
16 AOUC - Azienda Ospedaliero Universitaria Careggi [Firenze] = Careggi University Hospital [Florence, Italy]
17 ASST Fatebenefratelli-Sacco [Milan, Italy]
18 Unicatt - Università cattolica del Sacro Cuore = Catholic University of the Sacred Heart [Roma]
19 UPMC - Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie
2 UniMe - Università degli Studi di Messina = University of Messina
3 Unict - Università degli studi di Catania = University of Catania
4 University of Rome "Tor Vergeta"
5 IRCCS Ospedale San Raffaele [Milan, Italy]
6 Nippon Medical School [Tokyo, Japon]
7 UNIROMA - Università degli Studi di Roma "La Sapienza" = Sapienza University [Rome]
8 OR - Ospedale di Rivoli [Rivoli, Italy]
9 IdISSC - Instituto de Investigación Sanitaria del Hospital Clínico San Carlos [Madrid, Spain]
10 UCM - Universidad Complutense de Madrid = Complutense University of Madrid [Madrid]
11 SUM - Medical University of Silesia
12 Medical University of Warsaw - Poland
13 OSGB - Ospedale San Giovanni Bosco [Turin, Italy]
14 University Hospital “Maggiore della Carità” [Novara, Italy]
15 CP - Clinica Pederzoli [Peschiera del Garda, Italy]
16 AOUC - Azienda Ospedaliero Universitaria Careggi [Firenze] = Careggi University Hospital [Florence, Italy]
17 ASST Fatebenefratelli-Sacco [Milan, Italy]
18 Unicatt - Università cattolica del Sacro Cuore = Catholic University of the Sacred Heart [Roma]
19 UPMC - Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie
Guglielmo Gallone
- Fonction : Auteur
- PersonId : 805208
- ORCID : 0000-0001-8011-6844
Fabrizio d'Ascenzo
- Fonction : Auteur
- PersonId : 785116
- ORCID : 0000-0002-6646-9317
Giorgio Quadri
- Fonction : Auteur
- PersonId : 1222756
- ORCID : 0000-0003-4164-2758
Francesco Piroli
- Fonction : Auteur
- PersonId : 1222757
- ORCID : 0000-0001-6817-2923
Ovidio de Filippo
- Fonction : Auteur
- PersonId : 805209
- ORCID : 0000-0002-4915-9501
Giuseppe Venuti
- Fonction : Auteur
- PersonId : 1222758
- ORCID : 0000-0003-3486-1039
Andrea Montabone
- Fonction : Auteur
- PersonId : 1222759
- ORCID : 0000-0002-0954-8254
Radoslaw Parma
- Fonction : Auteur
- PersonId : 1222739
- ORCID : 0000-0002-7304-7315
Satoru Mitomo
- Fonction : Auteur
- PersonId : 1222760
- ORCID : 0000-0001-8972-4352
Enrico Cerrato
- Fonction : Auteur
- PersonId : 1222761
- ORCID : 0000-0002-1260-7534
Wojciech Wańha
- Fonction : Auteur
- PersonId : 1222762
- ORCID : 0000-0003-1220-9496
Bernardo Cortese
- Fonction : Auteur
- PersonId : 1222763
- ORCID : 0000-0002-5808-7810
Francesco Burzotta
- Fonction : Auteur
- PersonId : 1222764
- ORCID : 0000-0002-6569-9401
Résumé
Background: The PARIS risk score (PARIS-rs) and percutaneous coronary intervention complexity (PCI-c) predict clinical and procedural residual ischemic risk following PCI. Their accuracy in patients undergoing unprotected left main (ULM) or bifurcation PCI has not been assessed.
Methods: The predictive performances of the PARIS-rs (categorized as low, intermediate, and high) and PCI-c (according to guideline-endorsed criteria) were evaluated in 3,002 patients undergoing ULM/bifurcation PCI with very thin strut stents.
Results: After 16 (12-22) months, increasing PARIS-rs (8.8% vs. 14.1% vs. 27.4%, p < .001) and PCI-c (15.2% vs. 11%, p = .025) were associated with higher rates of major adverse cardiac events ([MACE], a composite of death, myocardial infarction [MI], and target vessel revascularization), driven by MI/death for PARIS-rs and target lesion revascularization/stent thrombosis for PCI-c (area under the curves for MACE: PARIS-rs 0.60 vs. PCI-c 0.52, p-for-difference < .001). PCI-c accuracy for MACE was higher in low-clinical-risk patients; while PARIS-rs was more accurate in low-procedural-risk patients. ≥12-month dual antiplatelet therapy (DAPT) was associated with a lower MACE rate in high PARIS-rs patients, (adjusted-hazard ratio 0.42 [95% CI: 0.22-0.83], p = .012), with no benefit in low to intermediate PARIS-rs patients. No incremental benefit with longer DAPT was observed in complex PCI.
Conclusions: In the setting of ULM/bifurcation PCI, the residual ischemic risk is better predicted by a clinical risk estimator than by PCI complexity, which rather appears to reflect stent/procedure-related events. Careful procedural risk estimation is warranted in patients at low clinical risk, where PCI complexity may substantially contribute to the overall residual ischemic risk.