Percutaneous coronary intervention outcomes based on American College of Cardiology/American Heart Association coronary lesion classification over 14 Years – Melbourne Interventional Group (MIG) Registry.

Abstract

Background: The American College of Cardiology/American Heart Association (ACC/AHA) introduced a coronary lesion classification to stratify coronary lesions for the probability of procedural success and complications after coronary angioplasty. Objective: Our aim was to assess the percutaneous coronary intervention (PCI) outcome over a 14-year period based on ACC/AHA classification. Methods: Consecutive procedures performed were divided into three periods. We analysed procedural characteristics, in-hospital and 30-day outcomes, and long-term National Death Index (NDI) mortality according to ACC/AHA lesion classification (A, B1, B2, C) in each period. Results: A total of 30,734 procedures were included with 10,098 in 2005–2009, 10,206 in 2010–2014, and 10,431 in 2015–2018 (p>0.05). An increased number of complex type C lesions were treated over time with 17%, 23%, and 27% of the total procedures in each period, respectively. PCI success and procedural success rates decreased with an increase in the complexity of the lesions in all three periods (both p<0.001). Moreover, in-hospital and 30-day mortality, major adverse cardiovascular events, major adverse cardiac and cerebrovascular events, and long-term NDI mortality increased with the increase in the complexity of the lesions in all three periods (all p<0.05). Conclusion: The ACC/AHA lesion classification is still predictive of PCI outcomes. PCI to more complex coronary lesions continues to be associated with lower procedural success rates, higher in-hospital and short-term morbidity and mortality, as well as long term-mortality.