Prevalence, clinical determinants and prognostic implications of coronary procedural complications of percutaneous coronary intervention in non-ST-segment elevation myocardial infarction: Insights from the contemporary multinational TAO trial.
Acute Coronary Syndrome
/ diagnostic imaging
Aged
Anticoagulants
/ therapeutic use
Cyclic N-Oxides
/ therapeutic use
Databases, Factual
Eptifibatide
/ therapeutic use
Factor Xa Inhibitors
/ therapeutic use
Female
Hemorrhage
/ epidemiology
Heparin
/ therapeutic use
Humans
Incidence
Male
Middle Aged
No-Reflow Phenomenon
/ epidemiology
Non-ST Elevated Myocardial Infarction
/ diagnostic imaging
Percutaneous Coronary Intervention
/ adverse effects
Platelet Aggregation Inhibitors
/ therapeutic use
Prevalence
Pyridines
/ therapeutic use
Randomized Controlled Trials as Topic
Recurrence
Risk Assessment
Risk Factors
Stroke
/ epidemiology
Time Factors
Treatment Outcome
Acute coronary syndrome
Angioplastie coronaire
Complications
Non-ST-segment elevation acute coronary syndrome
Percutaneous coronary intervention
Syndrome coronarien aigu
Journal
Archives of cardiovascular diseases
ISSN: 1875-2128
Titre abrégé: Arch Cardiovasc Dis
Pays: Netherlands
ID NLM: 101465655
Informations de publication
Date de publication:
Mar 2021
Mar 2021
Historique:
received:
17
04
2020
revised:
11
07
2020
accepted:
07
09
2020
pubmed:
2
2
2021
medline:
30
4
2021
entrez:
1
2
2021
Statut:
ppublish
Résumé
Few data are available on procedural complications of percutaneous coronary intervention (PCI) in the setting of acute coronary syndrome in the contemporary era. We sought to describe the prevalence of procedural complications of PCI in a non-ST-segment elevation acute coronary syndrome (NSTE ACS) cohort, and to identify their clinical characteristics and association with clinical outcomes. Patients randomized in TAO (Treatment of Acute coronary syndrome with Otamixaban), an international randomized controlled trial (ClinicalTrials.gov Identifier: NCT01076764) that compared otamixaban with unfractionated heparin plus eptifibatide in patients with NSTE ACS who underwent PCI, were included in the analysis. Procedural complications were collected prospectively, categorized and adjudicated by a blinded Clinical Events Committee, with review of angiograms. A multivariable model was constructed to identify independent clinical characteristics associated with procedural complications. A total of 8656 patients with NSTE ACS who were enrolled in the TAO trial underwent PCI, and 451 (5.2%) experienced at least one complication. The most frequent complications were no/slow reflow (1.5%) and dissection with decreased flow (1.2%). Procedural complications were associated with the 7-day ischaemic outcome of death, myocardial infarction or stroke (24.2% vs. 6.0%, odds ratio 5.01, 95% confidence interval 3.96-6.33; P<0.0001) and with Thrombolysis In Myocardial Infarction major and minor bleeding (6.2% vs. 2.3%, odds ratio 2.79, 95% confidence interval 1.86-4.2; P<0.0001). Except for previous coronary artery bypass grafting, multivariable analysis did not identify preprocedural clinical predictors of complications. In a contemporary NSTE ACS population, procedural complications with PCI remain frequent, are difficult to predict based on clinical characteristics, and are associated with worse ischaemic and haemorrhagic outcomes.
Sections du résumé
BACKGROUND
BACKGROUND
Few data are available on procedural complications of percutaneous coronary intervention (PCI) in the setting of acute coronary syndrome in the contemporary era.
AIM
OBJECTIVE
We sought to describe the prevalence of procedural complications of PCI in a non-ST-segment elevation acute coronary syndrome (NSTE ACS) cohort, and to identify their clinical characteristics and association with clinical outcomes.
METHODS
METHODS
Patients randomized in TAO (Treatment of Acute coronary syndrome with Otamixaban), an international randomized controlled trial (ClinicalTrials.gov Identifier: NCT01076764) that compared otamixaban with unfractionated heparin plus eptifibatide in patients with NSTE ACS who underwent PCI, were included in the analysis. Procedural complications were collected prospectively, categorized and adjudicated by a blinded Clinical Events Committee, with review of angiograms. A multivariable model was constructed to identify independent clinical characteristics associated with procedural complications.
RESULTS
RESULTS
A total of 8656 patients with NSTE ACS who were enrolled in the TAO trial underwent PCI, and 451 (5.2%) experienced at least one complication. The most frequent complications were no/slow reflow (1.5%) and dissection with decreased flow (1.2%). Procedural complications were associated with the 7-day ischaemic outcome of death, myocardial infarction or stroke (24.2% vs. 6.0%, odds ratio 5.01, 95% confidence interval 3.96-6.33; P<0.0001) and with Thrombolysis In Myocardial Infarction major and minor bleeding (6.2% vs. 2.3%, odds ratio 2.79, 95% confidence interval 1.86-4.2; P<0.0001). Except for previous coronary artery bypass grafting, multivariable analysis did not identify preprocedural clinical predictors of complications.
CONCLUSIONS
CONCLUSIONS
In a contemporary NSTE ACS population, procedural complications with PCI remain frequent, are difficult to predict based on clinical characteristics, and are associated with worse ischaemic and haemorrhagic outcomes.
Identifiants
pubmed: 33518473
pii: S1875-2136(21)00004-8
doi: 10.1016/j.acvd.2020.09.005
pii:
doi:
Substances chimiques
Anticoagulants
0
Cyclic N-Oxides
0
Factor Xa Inhibitors
0
Platelet Aggregation Inhibitors
0
Pyridines
0
Heparin
9005-49-6
Eptifibatide
NA8320J834
otamixaban
S173RED00L
Banques de données
ClinicalTrials.gov
['NCT01076764']
Types de publication
Comparative Study
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
187-196Informations de copyright
Copyright © 2021. Published by Elsevier Masson SAS.