Coronary Tortuosity and PCI Outcomes

Feb 24, 2021
Font Size
A
A
A
Authors:
Konigstein M, Ben-Yehuda O, Redfors B, et al.
Citation:
Impact of Coronary Artery Tortuosity on Outcomes Following Stenting: A Pooled Analysis From 6 Trials. JACC Cardiovasc Interv 2021;Feb 24:[Epub ahead of print].
Summary By:
Bina Ahmed, MD, FACC

Quick Takes

  • Moderate/severe coronary tortuosity is associated with increased short- and long-term target vessel failure.
  • There is increased risk of definite stent thrombosis at 5 years among patients with moderate/severe coronary tortuosity.
  • Moderate/severe tortuosity is an independent predictor of target vessel failure, target vessel MI, and ischemia-driven target vessel revascularization.

Study Questions:

Does coronary artery tortuosity impact clinical outcomes after percutaneous coronary intervention (PCI)?

Methods:

Individual patient data from six prospective, randomized stent trials were pooled. Outcomes at 30 days and 5 years following PCI of a single coronary lesion were analyzed according to the presence or absence of moderate/severe vessel tortuosity, as determined by an angiographic core laboratory. The primary endpoint was target vessel failure (TVF: composite of cardiac death, target vessel-related myocardial infarction [TV-MI], or ischemia-driven target vessel revascularization [ID-TVR]).

Results:

A total of 6,951 patients were included, 729 (10.5%) of whom underwent PCI in vessels with moderate/severe tortuosity. At 30 days, TVF was more frequent in patients with versus without moderate/severe tortuosity (3.8% vs. 2.4%, hazard ratio [HR], 1.64; 95% confidence interval [CI], 1.09-2.46; p = 0.02), a difference driven by a higher rate of TV-MI. At 5 years, TVF remained increased in patients with moderate/severe tortuosity (p = 0.003), driven by higher rates of TV-MI (p = 0.003) and ID-TVR (p = 0.01). Definite stent thrombosis was also greater in patients with versus without moderate/severe tortuosity (1.9% vs. 1.0%, HR, 1.86; 95% CI, 1.02-3.39; p = 0.04). After adjustment for baseline covariates, moderate/severe vessel tortuosity was independently associated with TV-MI and ID-TVR at 5 years (p = 0.04 for both).

Conclusions:

Stent implantation in vessels with moderate/severe coronary artery tortuosity is associated with increased rates of TVF due to greater rates of TV-MI and ID-TVR.

Perspective:

Data from this predominantly male cohort of patients suggest a relationship between coronary artery tortuosity and short- and long-term clinical outcomes after PCI. Tortuosity was defined and confirmed using core lab assessment. Patients with moderate/severe tortuosity had increased 30-day (driven by periprocedural and TV-MI) and 5-year (driven by TV-MI, ID-TVR, and definite stent thrombosis) TVF compared to those with no or mild tortuosity. Coronary tortuosity was an independent predictor of TVF at 5 years. Barring limitations (majority of data involved bare-metal stents and first-generation drug-eluting stents, retrospective analysis from multiple trials), coronary tortuosity may be an anatomic criterion to consider when assessing an individual patient’s risk for major adverse cardiac events post-PCI.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Atherosclerotic Disease (CAD/PAD), Aortic Surgery, Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Coronary Angiography, Coronary Artery Disease, Myocardial Infarction, Myocardial Ischemia, Myocardial Revascularization, Percutaneous Coronary Intervention, Stents, Thrombosis


< Back to Listings