ArticleHeart and vessels2026
The ARCADIA-ZERO registry: two-year outcomes of complex versus non-complex PCI with resolute onyx zotarolimus-eluting stent.
Article in Heart and vessels, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Drug-eluting stents (DES) have significantly advanced in the twenty-first century, enabling percutaneous coronary intervention (PCI) to treat increasingly complex coronary lesions. However, real-world data regarding outcomes of complex PCI remain limited. We aimed to compare the clinical outcomes between complex and non-complex PCI using a zotarolimus-eluting stent (ZES) registry in Japan. ARCADIA-ZERO is a multi-center registry of ZES from 65 Japanese institutions. Complex PCI was defined as chronic total occlusion (CTO), left main disease, bifurcation lesion requiring a 2-stent technique, lesions requiring a debulking device, use of ≥3 stents, and a total stent length of >60 mm. Device-oriented composite endpoints (DoCE) included cardiac death, spontaneous myocardial infarction, and target lesion revascularization, and were followed for 2 years. Patient characteristics, procedural characteristics, and DoCE were compared between complex and non-complex PCI groups. We analyzed 794 patients, including 257 with complex PCI and 537 with non-complex PCI. The most frequent reason for complex PCI was long stenting (41%), followed by CTO (36%), the need for an atherectomy device (28%), and left main disease (12%). Intravascular imaging was used in > 99% of all patients. The cumulative incidence of DoCE at 2 years was similar between complex and non-complex PCI (crude hazard ratio [HR], 1.14; 95% confidence interval [CI], 0.56-2.30; P=0.72; adjusted HR 1.09; 95% CI, 0.53-2.26; P=0.82). ZES demonstrated favorable clinical outcomes in both complex and non-complex percutaneous coronary intervention (PCI) in this Japanese multi-center registry.
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