Percutaneous coronary interventions for aneurysmatic right coronary artery in acute coronary syndrome: RIGHTMARE registry outcomes

The optimal strategy during percutaneous coronary intervention (PCI) of aneurysmatic right coronary artery (ARCA) remains uncertain and has never been tested in the acute setting. To compare the in-hospital and long-term outcomes of immediate and staged PCI strategies for ARCA as culprit lesions during acute coronary syndrome (ACS). Among 102.376 PCIs performed in 18 European centers, a total of 85 patients presenting with acute coronary syndrome undergoing ARCA PCI were finally included in the analysis. PCI strategy (stenting performed during the immediate vs staged procedure) and pharmacological approach adopted were collected. The primary outcome was procedural success (technical success without in-hospital MACE). The primary outcome occurred in 48.2 % of cases, with no significant differences observed between the immediate and staged PCI groups (50.9 % vs 43.3 %, p = 0.504). Patients in the staged-PCI group had a significantly higher rate of intravenous anticoagulant use (83.3 % vs 48.1 %, p = 0.002), BARC type 3 and 5 bleedings (12.9 % vs 1.9 %, p = 0.037), and longer in-hospital stay (7.40 ± 5.11 vs 9.5 ± 5.25 days, p = 0.049). After multivariate analysis, no independent predictors for procedural success were found in either group. Target lesion failure occurred in 24.1 % of cases without differences between groups at a median follow-up of three years. Among patients undergoing ARCA PCI in the setting of ACS, immediate or staged PCI were associated with similar in-hospital and long-term outcomes. However, staged PCI was associated with a higher risk of major bleeding events and longer length of stay compared to immediate PCI strategy. Central illustration. Immediate and long-term outcomes between immediate and staged-ARCA PCI group. TIMI, Thrombolysis In Myocardial Infarction; MACE, Major Cardiovascular and Cerebrovascular Events; BARC, Bleeding Academic Research Consortium. A: study cohort included 85 patients after reviewed 103.376 PCIs and screened 197 potentials candidates; B: procedural success rate between the immediate and staged-ARCA PCI group. The median time between coronary angiography and PCI in the staged group was 3.5 days; C: incidence rate of principal secondary outcomes including BARC type 3 and 5, In-Hospital MACE and TLF at 3-years between immediate and staged-ARCA PCI group. [Display omitted] •In patients undergoing PCI for ACS involving an ARCA as a culprit vessel, the optimal treatment strategy remains uncertain;•We aimed to com