Abstract 2001: Clinical and Angiographic Predictors of 30-Day and One-Year Ischemic Cardiac Events in Patients with Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention: An ACUITY Substudy
Background: Clinical predictors of short and long-term ischemic outcomes following PCI in acute coronary syndromes (ACS) have been well studied. However, the angiographic predictors of adverse events have not been defined.
Methods: The ACUITY trial randomized 13,819 pts with moderate and high risk ACS to unfractionated heparin or enoxaparin + GP IIb/Iii inhibitors (GPI), versus bivalirudin + GPI, vs. bivalirudin alone. The angiographic substudy of ACUITY included the first 7000 consecutive randomized US patients, of which 3664 underwent PCI. All angiograms were reviewed by an independent core laboratory for complete 3 vessel assessment of extent and CAD burden (total mm length of lesions with >30%DS), as well as baseline and final lesion and flow characteristics. Clinical and angiographic predictors of composite ischemia (death, non-fatal MI, or ischemic target vessel revascularization) at 30 days and 1 year were identified by univariate and multivariable analysis using logistic regression analysis.
Results: Coronary stents were used in 3429 (93.6%) pts, (84.4% DES). Composite ischemia occurred in 366 pts (10.0%) at 30 days and in 735 pts (21.0%) at one year. The independent predictors of 30 day and 1 year composite ischemic events by multivariable analysis are shown in the table⇓.
Conclusions: Beyond the clinical predictors of renal insufficiency and diabetes, CAD burden assessed by the number of diseased coronary vessels and the burden of CAD are independent predictor of 30 day and 1 year ischemic events in patients with ACS undergoing PCI. Baseline lesion specific characteristics including eccentric and calcified lesions, as well as angiographic PCI complications resulting in sustained no reflow, abrupt closure or thrombus were also independently predictive of adverse events.