| Description: |
Background While clinical outcomes after percutaneous coronary intervention (PCI) have improved in recent decades, cardiac death or myocardial infarction (MI) still occurs in patients undergoing contemporary PCI. An integrative risk model for post-PCI hard clinical endpoints incorporating clinical risk factors, angiographic and physiological vessel characteristics has not been established. Purpose To identify adverse clinical and vessel characteristics related to hard outcomes after PCI and to investigate their individual and combined prognostic implications. Methods From an individual patient data meta-analysis of 17 cohorts of patients who underwent post-PCI fractional flow reserve (FFR) measurement after drug eluting stent (DES) implantation, 2,081 patients with available 10 clinical characteristics (age, sex, clinical diagnosis at index procedure, diabetes, hypertension, dyslipidemia, smoking history, chronic kidney disease [CKD], prior myocardial infarction, left ventricular ejection fraction [LVEF]) and 8 vessel characteristics (target vessel, reference vessel diameter, % diameter stenosis, minimum lumen diameter [MLD], post-PCI % diameter stenosis, post-PCI MLD, total stent length in the target vessel, and post-PCI FFR) were analyzed. The least absolute shrinkage and selection operator (LASSO) model was applied for feature selection. The primary outcome was cardiac death or target vessel-MI at 2-years. Results The mean age of patients was 64.2±10.2 years, and the mean angiographic % diameter stenosis was 63.9±14.3%. Among 10 clinical and 8 vessel features, 4 adverse clinical characteristics (ACCs; age ≥65 years, diabetes, chronic kidney disease, and left ventricular ejection fraction |