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
Jeremie Abtan, Stephen D Wiviott, Emmanuel Sorbets, Batric Popovic, Yedid Elbez, Shamir R Mehta, Marc S Sabatine, Christoph Bode, Charles V Pollack, Marc Cohen, Tiziano Moccetti, Peep Laanmets, David Faxon, Andrzej Okreglicki, Gregory Ducrocq, Ph Gabriel Steg, TAO investigators, Jeremie Abtan, Stephen D Wiviott, Emmanuel Sorbets, Batric Popovic, Yedid Elbez, Shamir R Mehta, Marc S Sabatine, Christoph Bode, Charles V Pollack, Marc Cohen, Tiziano Moccetti, Peep Laanmets, David Faxon, Andrzej Okreglicki, Gregory Ducrocq, Ph Gabriel Steg, TAO investigators
Abstract
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: 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: 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: 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: 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.
Keywords: Acute coronary syndrome; Angioplastie coronaire; Complications; Non-ST-segment elevation acute coronary syndrome; Percutaneous coronary intervention; Syndrome coronarien aigu.
Copyright © 2021. Published by Elsevier Masson SAS.
Source: PubMed