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Angiographic predictors of adverse outcomes after percutaneous coronary intervention in patients with radiation associated coronary artery disease
Author(s) -
Reed Grant W.,
Rossi Jeffrey E.,
Masri Ahmad,
Griffin Brian P.,
Ellis Stephen G.,
Kapadia Samir R.,
Desai Milind Y.
Publication year - 2019
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28107
Subject(s) - medicine , percutaneous coronary intervention , cardiology , conventional pci , myocardial infarction , coronary artery disease , stroke (engine) , hazard ratio , proportional hazards model , stenosis , population , confidence interval , mechanical engineering , environmental health , engineering
Objectives To determine procedural predictors of long‐term outcomes for patients with radiation associated coronary artery disease (CAD) treated with percutaneous coronary intervention (PCI). Background Patients who develop CAD after external beam radiation therapy (XRT) for cancer are at high‐risk for adverse events following PCI. It is unknown if specific angiographic features can predict outcomes in this population. Methods This is an observational study of 157 patients with malignancy who received XRT prior to PCI. Rates of major adverse cardiovascular and cerebrovascular events (MACCEs; all‐cause mortality, myocardial infarction, repeat revascularization, or stroke) were compared across patient characteristics over time with the Cox proportional hazards and Kaplan–Meier's analyses. Results During follow‐up of 5.4 ± 4.5 years, 91 (58%) patients had MACCE. On Kaplan–Meier's analysis of angiographic characteristics, MACCE was more frequent in patients with at least moderate target vessel calcification ( P = 0.023), ostial stenosis ( P = 0.049), target vessel diameter ≥ 3.0 mm ( P = 0.018), a SYNTAX score ≥ the median of 11 ( P = 0.014), or bare metal stenting (BMS)/balloon angioplasty (BA) compared to drug‐eluting stenting (DES) ( P = 0.006). Cardiac death was more frequent in patients with SYNTAX score ≥ 11 ( P = 0.028) or BMS ( P = 0.043). After multivariable adjustment for both angiographic and clinical characteristics, independent predictors of MACCE were BMS placement ( P = 0.013), chronic kidney disease ≥ stage 3 ( P = 0.019), New York Heart Association (NYHA) heart failure class ≥3 ( P = 0.034), and SYNTAX score ≥ 11 ( P = 0.041). Conclusions In patients previously exposed to XRT treated with PCI, independent angiographic predictors of MACCE include SYNTAX score ≥ 11 and BMS placement, suggestive that DES should be preferred in this population.