Coronary disease severity is important for patients presenting with Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS). However, long-term outcome in patients undergoing Percutaneous Coronary Intervention (PCI) with High-Risk Coronary Anatomy (HRCA) is still unknown. We aim to evaluate the long-term prognosis of NSTE-ACS patients with HRCA.

Patients presenting as NSTE-ACS undergoing PCI in Fuwai Hospital in 2013 were prospectively enrolled and were subsequently divided into HRCA group and Low-Risk Coronary Anatomy (LRCA) group according to whether coronary angiographic anatomy complies with the HRCA definition. HRCA was defined as left main disease >50%, proximal lesion >70%, or 2- to 3- vessel disease involving the LAD. Prognosis impact on 2-year major adverse cardiovascular and cerebrovascular events (MACCE) is analyzed.

Out of 4,984 enrolled patients with NSTE-ACS, 3,752 patients belonged to HRCA group, while 1,232 patients belonged to LRCA group. Compared with LRCA group, patients in HRCA group had worse baseline characteristics including higher age, more comorbidities and worse angiographic findings. Patients in HRCA group had higher incidence of 2-year unplanned revascularization (9.7% vs. 5.1%, p<0.001) and MACCE (13.1% vs. 8.8%, p<0.001). Kaplan-Meier survival analysis showed similar results. After adjusting for confounding factors, HRCA is independently associated with higher risk of 2-year revascularization (HR = 1.636, 95% CI = 1.225 - 2.186, p = 0.001) and MACCE (HR = 1.275, 95% CI = 1.019 - 1.596, p = 0.034).

In our large cohort of Chinese patients, HRCA is associated higher incidence of 2-year unplanned revascularization and MACCE. HRCA is an independent risk factor for 2-year unplanned revascularization and MACCE.