Long-term outcomes of percutaneous coronary intervention for recurrent events in patients undergoing target-vessel vs. nontarget-vessel revascularization

Abstract

Aims: To compare long-term outcomes of repeat percutaneous coronary intervention (PCI) in patients with chronic coronary syndrome, distinguishing between target-vessel revascularization (TVR) and nontarget-vessel revascularization (non-TVR), and to identify predictors of major adverse cardiovascular events (MACE).

Methods: We analyzed consecutive patients with prior PCI undergoing repeat PCI for recurrent ischemia. Patients were classified as TVR or non-TVR. The primary endpoint was MACE (all-cause death, myocardial infarction, or repeat revascularization) at 3, 5, and 10 years. Cox regression identified independent predictors.

Results: Among 299 patients, 51.8% underwent TVR and 48.2% non-TVR. Left anterior descending (LAD) was more often treated in TVR (58.1 vs. 36.5%, P = 0.003). At 3 years, MACE occurred in 37.3% of TVR and 28.8% of non-TVR (hazard ratio 1.51, P = 0.052), with similar trends at 5 and 10 years. Independent predictors of MACE included cardiogenic shock, longer fluoroscopy time, and LAD involvement. Intravascular imaging was used in 5.7% and functional assessment in 2.6%, both below contemporary acute coronary syndrome registry averages. Nearly half of patients had LDL-C more than 55 mg/dL despite prior PCI.

Conclusion: Patients requiring repeat PCI, whether for the same or a different vessel, face high long-term event rates. Adverse prognosis is determined by clinical severity, procedural complexity, and high-risk anatomy. Greater adoption of imaging-guided PCI and intensive secondary prevention may help break the cycle of recurrent events.

Keywords: acute coronary syndrome; major adverse cardiovascular events; nontarget vessel revascularization; percutaneous coronary intervention; target-vessel revascularization.