Results of systematic patient outcome monitoring: Does post-dilatation during angiography-guided percutaneous coronary intervention improve clinical outcomes?

Stacey R Slingerland; Konrad A J van Beek; Daniela N Schulz; Gijs J van Steenbergen; Tim Brouwer; Martin Stoel; Pieter-Jan Vlaar; Pim A Tonino; Lukas Dekker; Lokien X van Nunen; Koen Teeuwen; Dennis van Veghel

doi:10.1016/j.hjc.2023.11.004

Results of systematic patient outcome monitoring: Does post-dilatation during angiography-guided percutaneous coronary intervention improve clinical outcomes?

Hellenic J Cardiol. 2023 Nov 16:S1109-9666(23)00223-3. doi: 10.1016/j.hjc.2023.11.004. Online ahead of print.

Affiliations

¹ Heart Center, Catharina Hospital, Eindhoven, the Netherlands.
² Department of Cardiology, Medisch Spectrum Twente, Enschede, the Netherlands.
³ Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
⁴ Heart Center, Catharina Hospital, Eindhoven, the Netherlands. Electronic address: dennis.v.veghel@catharinaziekenhuis.nl.

PMID: 37979617
DOI: 10.1016/j.hjc.2023.11.004

Abstract

Objectives: This study evaluates clinical outcomes after implementing a liberal post-dilatation strategy during PCI.

Background: Post-dilatation after percutaneous coronary intervention (PCI) is performed to achieve optimal stent expansion and reduce complications. However, its prognostic effects are unclear and conflicting.

Methods: This study is a pre-post-intervention analysis of two cohorts, before (2015-2017) and after (2018-2020) implementation of a liberal post-dilatation strategy. The primary end point consisted of major adverse cardiovascular events (MACE) at 30 days. Secondary end points consisted of the individual components of the primary end point as well as 1 year mortality and target vessel revascularization.

Results: A total of 10,153 patients were included: 5,383 in the pre-cohort and 4,770 in the post-cohort. The 30-day MACE was 5.00% in the pre-cohort and 4.09% in the post-cohort (p = 0.008; OR 0.75 (CI 0.61-0.93)). There was a significant difference between the pre- and post-cohort in 30-day mortality, respectively, 2.91% and 2.25% (p = .01; OR 0.70 (CI 0.53-0.93)), and MI at 30 days, 1.17% versus 0.59% (p = .003; OR 0.49 (CI 0.31-0.78)). At 1 year, there was a significant difference in mortality between the pre-cohort, 5.84%, and post-cohort, 5.19% (p = .02; OR 0.79 (CI 0.66-0.96)).

Conclusions: A liberal post-dilatation strategy after PCI was associated with a significant decrease in 30-day MACE, 30-day MI, 30-day mortality, and 1-year mortality. Future studies are warranted to validate the causality between post-dilatation and improvement of clinical outcomes.

Keywords: Balloon dilatation; Clinical outcomes; MACE; Percutaneous coronary intervention; Post-dilatation.