Volume 92, Issue 3 pp. E227-E234
Coronary Artery Disease (E-only Articles)

Utility of the ACC/AHA lesion classification as a predictor of procedural, 30-day and 12-month outcomes in the contemporary percutaneous coronary intervention era

James Theuerle BSc, MBBS, MSc

James Theuerle BSc, MBBS, MSc

Department of Cardiology, Austin Health, Melbourne

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Matias B Yudi MBBS

Matias B Yudi MBBS

Department of Cardiology, Austin Health, Melbourne

Department of Medicine, University of Melbourne, Melbourne

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Omar Farouque MBBS, PhD

Omar Farouque MBBS, PhD

Department of Cardiology, Austin Health, Melbourne

Department of Medicine, University of Melbourne, Melbourne

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Nick Andrianopoulos MBBS, MBiostat

Nick Andrianopoulos MBBS, MBiostat

Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne

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Peter Scott MBBS

Peter Scott MBBS

Department of Cardiology, Austin Health, Melbourne

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Andrew E Ajani MBBS, MD

Andrew E Ajani MBBS, MD

Department of Medicine, University of Melbourne, Melbourne

Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne

Department of Cardiology, Royal Melbourne Hospital, Melbourne

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Angela Brennan RN

Angela Brennan RN

Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne

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Stephen J Duffy MBBS, PhD

Stephen J Duffy MBBS, PhD

Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne

Department of Cardiovascular Medicine, Alfred Hospital, Melbourne

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Christopher M Reid BA, MSc, PhD

Christopher M Reid BA, MSc, PhD

Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne

School of Public Health, Curtin University, Perth, Australia

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David J Clark MBBS, DMedSci

Corresponding Author

David J Clark MBBS, DMedSci

Department of Cardiology, Austin Health, Melbourne

Department of Medicine, University of Melbourne, Melbourne

Correspondence David Clark, Head, Interventional Cardiology Research, Austin Health, 145 Studley Road, Heidelberg, Victoria 3084, Australia. Email: [email protected]Search for more papers by this author
on behalf of the Melbourne Interventional Group.

on behalf of the Melbourne Interventional Group.

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First published: 15 November 2017
Citations: 27

Abstract

Background

Correlations between the ACC/AHA coronary lesion classification and clinical outcomes in the contemporary percutaneous coronary intervention (PCI) era are not well established.

Methods

We 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 (MIG) registry. Patients presenting with STEMI, 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.

Results

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 prior bypass graft surgery (all P < 0.01). They were also more likely to require rotational atherectomy, drug-eluting stents and longer stent lengths (all P < 0.01). Increasing lesion complexity was associated with lower procedural success (99.6% vs. 99.1% vs. 96.6% vs. 82.7%, P < 0.001) and worse 30-day (0.2% vs. 0.3% vs. 0.7% vs. 0.6%, P < 0.001) and 12-month mortality (2.2% vs. 2.0% vs. 3.2% vs. 2.9%, P <0.01). Kaplan Meier analysis showed complex lesions (type B2 and C) had lower survival at 12-months (P = 0.003).

Conclusions

PCI to 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 preprocedure to predict acute PCI success and clinical outcomes.

CONFLICT OF INTEREST

Nothing to report.

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