Comparison of Long-Term Clinical Outcomes of Elective Percutaneous Coronary Intervention Between Complex and High-risk Intervention in Indicated Patients (CHIP) versus Non-CHIP

Fujimoto, Yudai; Sakakura, Kenichi; Jinnouchi, Hiroyuki; Taniguchi, Yousuke; Tsukui, Takunori; Watanabe, Yûsuke; Yamamoto, Kei; Seguchi, Masaru; Wada, Hiroshi; Fujita, Hideo

doi:10.1016/j.amjcard.2023.02.010

Cited by 5 publications

(1 citation statement)

References 20 publications

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“…Fujimoto et al showed that pulmonary disease, active malignancy, unstable hemodynamics, hemodialysis, left ventricular ejection fraction, and valvular disease significantly increased the MACE risk [ 42 ]. In their other paper, the same group showed that frailty (OR 2.04, 95% CI 1.10–3.75, p = 0.022), unstable hemodynamics (OR 5.75, 95% CI 1.21–27.20, p = 0.027), and immunosuppressive drugs (OR 3.04, 95% CI 1.25–7.38, p = 0.014) were linked with the increased risk of major complications in CHIP patients [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes and Prognostic Factors in Complex, High-Risk Indicated Procedure (CHIP) and High-Bleeding-Risk (HBR) Patients Undergoing Percutaneous Coronary Intervention with Sirolimus-Eluting Stent Implantation: 4-Year Results

Tyczyński

Kern

Buller³

et al. 2023

JCM

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We aimed to characterize the performance and safety of percutaneous coronary intervention (PCI) in complex, high-risk indicated procedure (CHIP) and high-bleeding-risk (HBR) patients at a 4-year follow up. We included all consecutive patients who underwent PCI with the sirolimus-eluting coronary stent Alex Plus (Balton, Poland) between July 2015 and March 2016. We analyzed various baseline demographic and clinical characteristics, laboratory data, and clinical outcomes. We enrolled 232 patients in whom 282 stents were implanted, including 81 patients meeting the CHIP criteria and 76 patients meeting the HBR criteria. In the whole population, the mean age was 68 11 years, and 23.7% were females. Most procedures were performed from radial access (83.2%) using a 6F guiding catheter (95.7%). The lesions were mostly predilated (61.6%), and postdilatation was performed in 37.9%. The device success was 99.6% (in one case, a second stent was required due to heavy calcifications). Additional stents were deployed in 39% of cases due to edge dissection (6.9%), side branch stenting (5.2%), or diffuse disease (26.9%). Myocardial infarction (MI) type 4a was revealed in 2.2% of cases. At 4 years, the MACE rates for the whole population and for CHIP and HBR patients were 23.3%, 29.6%, and 27.6%, respectively. CHIP patients had a higher risk of MACEs (29.6% vs. 19.9%, HR 1.69, p = 0.032) and cardiac death (11.1% vs. 4.6%, HR 2.50, p = 0.048). There were no differences for MI (7.4% vs. 6.6%, p = 0.826) and TLR (18.5% vs. 12.6%, p = 0.150). HBR patients were also characterized by a higher risk of MACEs (27.6% vs. 21.2%, HR 1.84, p = 0.049) and cardiac death (17.1% vs. 1.9%, HR 9.61, p < 0.001). There were no differences for MI (7.9% vs. 6.4%, p = 0.669) and TLR (11.8% vs. 16.0%, p = 0.991). PCI in CHIP and HBR patients is feasible with a low rate of periprocedural complications. Nevertheless, CHIP and HBR patients are at a high risk of future adverse events and require strict surveillance to improve outcomes.

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Section: Discussionmentioning

confidence: 99%

Clinical Outcomes and Prognostic Factors in Complex, High-Risk Indicated Procedure (CHIP) and High-Bleeding-Risk (HBR) Patients Undergoing Percutaneous Coronary Intervention with Sirolimus-Eluting Stent Implantation: 4-Year Results

Tyczyński

Kern

Buller³

et al. 2023

JCM

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Application of Drug‐Coated Balloons in Complex High Risk and Indicated Percutaneous Coronary Interventions

Somsen,

Rissanen,

Hoek

et al. 2024

Cathet Cardio Intervent

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There is a growing trend of patients with significant comorbidities among those referred for percutaneous coronary intervention (PCI). Consequently, the number of patients undergoing complex high risk indicated PCI (CHIP) is rising. CHIP patients frequently present with factors predisposing to extensive drug‐eluting stent (DES) implantation, such as bifurcation and/or heavily calcified coronary lesions, which exposes them to the risks associated with an increased stent burden. The drug‐coated balloon (DCB) may overcome some of the limitations of DES, either through a hybrid strategy (DCB and DES combined) or as a leave‐nothing‐behind strategy (DCB‐only). As such, there is a growing interest in extending the application of DCB to the CHIP population. The present review provides an outline of the available evidence on DCB use in CHIP patients, which comprise the elderly, comorbid, and patients with complex coronary anatomy. Although the majority of available data are observational, most studies support a lower threshold for the use of DCBs, particularly when multiple CHIP factors coexist within a single patient. In patients with comorbidities which predispose to bleeding events (such as increasing age, diabetes mellitus, and hemodialysis) DCBs may encourage shorter dual antiplatelet therapy duration—although randomized trials are currently lacking. Further, DCBs may simplify PCI in bifurcation lesions and chronic total coronary occlusions by reducing total stent length, and allow for late lumen enlargement when used in a hybrid fashion. In conclusion, DCBs pose a viable therapeutic option in CHIP patients, either as a complement to DES or as stand‐alone therapy in selected cases.

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Complex and high-risk intervention in indicated patients (CHIP) in contemporary clinical practice

Fujimoto

Sakakura

Fujita

2023

Cardiovasc Interv and Ther

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Comparison of Long-Term Clinical Outcomes of Elective Percutaneous Coronary Intervention Between Complex and High-risk Intervention in Indicated Patients (CHIP) versus Non-CHIP

Cited by 5 publications

References 20 publications

Clinical Outcomes and Prognostic Factors in Complex, High-Risk Indicated Procedure (CHIP) and High-Bleeding-Risk (HBR) Patients Undergoing Percutaneous Coronary Intervention with Sirolimus-Eluting Stent Implantation: 4-Year Results

Clinical Outcomes and Prognostic Factors in Complex, High-Risk Indicated Procedure (CHIP) and High-Bleeding-Risk (HBR) Patients Undergoing Percutaneous Coronary Intervention with Sirolimus-Eluting Stent Implantation: 4-Year Results

Application of Drug‐Coated Balloons in Complex High Risk and Indicated Percutaneous Coronary Interventions

Complex and high-risk intervention in indicated patients (CHIP) in contemporary clinical practice

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