Implementation of the best practice principle in contemporary percutaneous coronary intervention

Coronary artery disease (CAD) is the most common type of heart disease and the leading cause of death. Percutaneous coronary intervention (PCI) for CAD has become the most frequently performed therapeutic procedure in medicine. Despite the tremendous evolution in PCI, three-vessel disease (3VD) remains the most challenging subset of patients for PCI. In this thesis we evaluated the impact of contemporary best practice PCI strategy for patients with 3VD and explored further development of this strategy. The contemporary best practice PCI strategy so called SYNTAX-II strategy includes: heart team decision-making utilizing the SYNTAX Score II (a clinical tool combining anatomical and clinical factors), coronary physiology guided revascularization, implantation of thin strut bioresorbable-polymer drug-eluting stents, intravascular ultrasound (IVUS) guided stent implantation, contemporary chronic total occlusion revascularization techniques and guideline-directed medical therapy. The SYNTAX II strategy demonstrated a clear improvement in clinical outcomes up to 2 years after PCI for 3VD within a 9-year lapse of time between the enrolment periods of the SYNTAX I and II. According to the finding of this thesis, we considered the possibility of further updates in individual components of the best practice PCI strategy: i) use of ultra-thin strut DES; ii) angiography-derived FFR guided-PCI; iii) novel antiplatelet regimen such as short DAPT followed by potent P2Y12 monotherapy. A novel best practice PCI strategy including suggested updates will be evaluated among patients with 3VD in the ongoing Multivessel TALENT trial.