Mini-Focus on Acute Coronary Syndromes
Clinical Research
Association Between Angiographic Complications and Clinical Outcomes Among Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: An EARLY ACS (Early Glycoprotein IIb/IIIa Inhibition in Non–ST-Segment Elevation Acute Coronary Syndrome) Angiographic Substudy

https://doi.org/10.1016/j.jcin.2012.05.007Get rights and content
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Objectives

The goal of this analysis was to determine the association between intraprocedural complications and clinical outcomes among patients with high-risk non–ST-segment elevation acute coronary syndrome (NSTEACS) undergoing percutaneous coronary intervention (PCI).

Background

Among patients undergoing PCI for NSTEACS, the relationship between intraprocedural complications and clinical outcomes, independent of epicardial and myocardial perfusion, has not been well characterized.

Methods

The EARLY ACS (Early Glycoprotein IIb/IIIa Inhibition in Non–ST-Segment Elevation Acute Coronary Syndrome) trial enrolled 9,406 patients with high-risk NSTEACS undergoing an early invasive strategy. Of these, 1,452 underwent angiographic assessment in an independent core laboratory and did not have a myocardial infarction (MI) between enrollment and angiography. We assessed the relationship between abrupt closure, loss of side branch(es), distal embolization, and no-reflow phenomenon and 30-day clinical outcomes in these patients.

Results

Of the patients, 166 (11.4%) experienced an intraprocedural complication. Baseline clinical characteristics were similar between patients who did and did not have complications. The 30-day composite of death or MI was significantly higher among patients with an intraprocedural complication (28.3% vs. 7.8%, odds ratio [OR]: 4.68, 95% confidence interval [CI]: 3.2 to 7.0, p < 0.001). Individually, both mortality (3.0% vs. 0.9%, OR: 3.60, 95% CI: 1.2 to 10.5, p = 0.019) and MI (27.1% vs. 7.4%, OR: 4.66, 95% CI: 3.1 to 7.0, p < 0.001) were significantly increased. After adjusting for differences in post-PCI epicardial and myocardial perfusion, the association with 30-day death or MI remained significant.

Conclusions

Among high-risk NSTEACS patients undergoing an invasive strategy, the incidence of intraprocedural complications is high, and the occurrence of these complications is associated with worse clinical outcomes independent of epicardial and myocardial perfusion.

(Early Glycoprotein IIb/IIIa Inhibition in Patients With Non–ST-segment Elevation Acute Coronary Syndrome [EARLY ACS]; NCT00089895)

Key Words

acute coronary syndrome
complications
percutaneous coronary intervention

Abbreviations and Acronyms

CI
confidence interval
cTFC
corrected Thrombolysis In Myocardial Infarction frame count
MI
myocardial infarction
NSTEACS
non–ST-segment elevation acute coronary syndrome
OR
odds ratio
PCI
percutaneous coronary intervention
TFG
Thrombolysis In Myocardial Infarction flow grade
TIMI
Thrombolysis In Myocardial Infarction
TMPG
Thrombolysis In Myocardial Infarction myocardial perfusion grade

Cited by (0)

The EARLY ACS trial was supported by Schering-Plough and Millennium Pharmaceuticals. All authors received research grant support from the sponsor of the trial, Merck-Schering Plough. Dr. Giugliano has received honoraria from Merck-Schering Plough as a consultant and for continuing medical education lectures. Dr. Newby has received research grant funding for EARLY ACS through Duke/Duke Clinical Research Institute from Merck-Schering Plough, Amgen, Inc., Amylin, Astra Zeneca, Eli Lilly, Daiichi-Sankyo, diaDexus, Bristol Myers Squibb, Genentech, GlaxoSmithKline, Johnson & Johnson, Merck, Murdock Study, Regado Biosciences, NHLBI, Novartis, Roche. Dr. Braunwald has received consulting fees, lecture fees, and grant support from Eli Lilly, Johnson & Johnson, Merck and Bayer. Dr. Califf has received consulting fees and grant support from, Amylin, Kowa Research Institute, Merck-Schering Plough, Nile, NITROX LLC, Parkview, Bristol Myers Squibb, Novartis, Orexigen Therapeutics, Pozen, Servier International, Johnson & Johnson, Roche, Merck, Regado, Bayer, and Web M.D. Dr. Harrington has received consulting fees, lecture fees, and grant support from Merck-Schering Plough, Sanofi, Lilly, Daiichi-Sankyo, Bristol-Myers Squibb, Novartis, AstraZeneca, Johnson & Johnson, Portola, Merck, Regado, and Web M.D. Dr. Gibson has received consulting fees from Merck-Schering Plough.