• Philippe Généreux, Gennaro Giustino, Björn Redfors, Tullio Palmerini, Bernhard Witzenbichler, Giora Weisz, Thomas D Stuckey, Akiko Maehara, Roxana Mehran, Ajay J Kirtane, and Gregg W Stone.
• Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA; Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada. Electronic address: pgenereux@crf.org.
• Int. J. Cardiol. 2018 Oct 1; 268: 61-67.

BackgroundRisk stratification after percutaneous coronary intervention (PCI) is mainly based on demographics and clinical presentation (stable coronary artery disease [CAD] vs. acute coronary syndromes [ACS]). We investigated the impact of PCI extent and complexity on 2-year clinical outcomes after successful implantation of drug-eluting stents (DES) and whether this effect is influenced by clinical presentation and/or high platelet reactivity (HPR) on clopidogrel.Methods And ResultsPatients from the prospective, multicenter Assessment of Dual Antiplatelet Therapy with Drug-Eluting Stents study were stratified according to PCI complexity, with complex PCI (C-PCI) defined as ≥3 stents implanted, bifurcation PCI with 2 stents, rotational atherectomy use for severely calcified lesions, or left main or saphenous vein graft (SVG) PCI. Major adverse cardiac events (MACE; cardiac death, myocardial infarction, and stent thrombosis) were compared at 2-year follow-up in patients with and without C-PCI. Successful DES PCI was performed in 8582 patients-2255 (26.3%) with C-PCI. C-PCI was independently associated with higher 2-year risk of MACE (adjusted HR [adjHR]: 1.56; 95%CI: 1.29-1.89; p<0.0001), MI (adjHR: 1.71; 95%CI: 1.37-2.14; p<0.0001), and ST (adjHR: 2.26; 95%CI: 1.42-3.59; p=0.0006). The association between C-PCI vs. non-C-PCI and the risk of MI and ST was greater in stable CAD than in ACS (Pinteraction=0.04 and 0.03, respectively). SVG PCI, 2-stent bifurcation treatment, and implantation of ≥3 stents were independently associated with MACE.ConclusionsPatients undergoing extensive and more complex PCI experienced worse outcomes after successful PCI. Considering the extent and complexity of PCI revascularization may improve risk stratification.Copyright © 2017. Published by Elsevier B.V.

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