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Title: 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
Austin Authors: Theuerle, James D ;Yudi, Matias B ;Farouque, Omar ;Andrianopoulos, Nick;Scott, Peter ;Ajani, Andrew E;Brennan, Angela L;Duffy, Stephen J;Reid, Christopher M;Clark, David J ;Melbourne Interventional Group
Affiliation: Cardiology
Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia
Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Victoria, Australia
School of Public Health, Curtin University, Perth, WA, Australia
Issue Date: 2018
Date: 2017-11-15
Publication information: Catheterization & Cardiovascular Interventions 2018; 92(3): E227-E234
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.
DOI: 10.1002/ccd.27411
Journal: Catheterization & Cardiovascular Interventions
PubMed URL:
Type: Journal Article
Subjects: Lesion complexity
Clinical outcomes
Appears in Collections:Journal articles

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