Utility of ACC/AHA Lesion Classification Studied as Predictor of PCI Outcomes
November 20, 2017—In a study that was published online in Catheterization and Cardiovascular Interventions, James Theuerle, MBBS, et al investigated correlations between the American College of Cardiology/American Heart Association (ACC/AHA) coronary lesion classification and the clinical outcomes seen in contemporary percutaneous coronary intervention (PCI).
As reported in Catheterization and Cardiovascular Interventions, the investigators analyzed clinical characteristics and outcomes according to ACC/AHA lesion classification (A, B1, B2, C) in 13,701 consecutive patients from the Melbourne Interventional Group registry. Patients presenting with ST-elevation myocardial infarction, cardiogenic shock, and out-of-hospital cardiac arrest were excluded. The primary endpoints were 30-day and 12-month mortality. Secondary endpoints were procedural success, as well as 30-day and 12-month major adverse cardiac events.
Of the 13,701 patients treated, 1,246 (9.1%) had type A lesions; 5,519 (40.3%) had type B1 lesions; 4,449 (32.5%) had type B2 lesions; and 2,487 (18.2%) had type C lesions. Patients with type C lesions were more likely to be older and have impaired renal function, diabetes, previous myocardial infarction, peripheral vascular disease, and previous bypass graft surgery (P < .01). They were also more likely to require rotational atherectomy, drug-eluting stents, and longer stent lengths (P < .01). Furthermore, increasing lesion complexity was associated with lower procedural success (99.6%, 99.1%, 96.6%, and 82.7%, respectively; P < .001) and worse 30-day (0.2%, 0.3%, 0.7%, and 0.6%; P < .001) and 12-month mortality (2.2%, 2.0%, 3.2%, and 2.9%; P < .01). Kaplan-Meier analysis showed that complex lesions (type B2 and C) were associated with lower survival rates at 12 months (P =.003).
PCI for more complex lesions continues to be associated with lower procedural success rates, as well as inferior medium-term clinical outcomes. Thus, the ACC/AHA lesion classification should still be calculated preprocedurally to predict acute PCI success and clinical outcomes, concluded the investigators in Catheterization and Cardiovascular Interventions.