The Impact of Coronary Tortuosity on Clinical Outcomes of Patients Undergoing PCI: An Individual Patient Data Pooled Analysis From 6 Randomized Controlled Trials

Background: Coronary tortuosity is a common angiographic finding. The impact of coronary tortuosity on clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) has not been well described. We therefore evaluated the outcomes of patients undergoing PCI with vs without moderate/severe coronary tortuosity.

Methods: Patient-level data from 6 prospective, randomized trials were pooled, and clinical 30-day and 5-year outcomes of patients undergoing PCI according to the presence or absence of moderate/severe vessel tortuosity, as determined by an angiographic core laboratory, were analyzed. The primary endpoint was target vessel failure (TVF; composite of cardiac death, target vessel myocardial infarction [TV-MI], or target vessel revascularization [TVR]).

Results: A total of 7148 patients (62.8±10.8 years, 28.9% women) were included in the analysis, 759 (10.6%) of whom underwent PCI in vessels with moderate/severe vessel tortuosity. Patients with vessel tortuosity were older, more frequently hypertensive, and had a higher prevalence of prior revascularization. At 30 days, TVF was higher in patients with vs without moderate/severe tortuosity (3.7% vs 2.3%, HR 1.58, 95%CI 1.06-2.37, p=0.02), a difference driven by a higher rate of TV-MI. At 5 years, TVF remained higher after PCI in patients with vs without moderate/severe tortuosity (25.2% vs 20.5%, HR 1.26, 95%CI 1.08-1.47, p=0.003), driven by higher rates of TV-MI (6.2% vs 4.0%, HR 1.56, 95%CI 1.14-2.15, p=0.006) and TVR (19.7% vs 16.2%, HR 1.24, 95%CI 1.04-1.48, p=0.02). Stent thrombosis at 5 years occurred in 2.0% vs 1.3% of patients with and without vessel tortuosity, respectively (HR 1.52, 95%CI 0.86-2.69, p=0.15). After adjustment for baseline covariates, moderate/severe vessel tortuosity was independently associated with TVF at 5 years (adjHR 1.27, 95%CI 1.05-1.53, p=0.01).

Conclusions: PCI in vessels with moderate/severe coronary tortuosity is associated with higher rates of TVF, driven by increased rates of TV-MI and TVR