Abstract 9472: Comparison of Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention for Previously Stented versus De Novo Culprit Lesions: Insights from the National Cardiovascular Data Registry CathPCI Registry
Background: A previously stented coronary lesion often requires a different interventional approach than a de novo lesion, yet patient presentation, treatment patterns and outcomes, particularly in the acute coronary syndrome (ACS) setting, have not previously been compared.
Methods: We examined ACS patients with at least 1 prior coronary stent in the NCDR CathPCI Registry undergoing percutaneous coronary intervention (PCI) between Jan 2005 and Jun 2009. Patients were divided by culprit lesion into 1) prior drug eluting stent (DES) culprit; 2) prior bare metal stent (BMS) culprit; and 3) de novo culprit. Patient, lesion, and procedural characteristics and in hospital outcomes were compared between groups. Results Among 52,313 ACS patients undergoing PCI, 11,020 (21%) had a culprit lesion previously stented with either a DES (n = 5,992) or a BMS (n = 5,028). Compared to patients with a de novo culprit, patients with a previously stented culprit were younger, more likely to present with ST segment elevation myocardial infarction (STEMI), cardiogenic shock and have pre procedure TIMI 0 or 1 flow (all p < 0.0001). Patients with a prior DES culprit were more likely to present with STEMI, have greater flow impairment and visible thrombus in the stent (11.2% v. 6.7%, p < 0.0001) than patients with a prior BMS culprit. Culprit lesions were more likely to be treated with DES in the de novo and prior BMS culprit groups, whereas patients with a prior DES culprit lesion were the least likely to be re-stented. Procedural and clinical outcomes were similar between groups.
Conclusions: PCI in the ACS setting frequently involves repeat revascularization of a previously stented culprit lesion. Patients with a previously stented culprit have a more acute clinical and angiographic presentation than patients with a de novo culprit, with prior DES worse than prior BMS. A better understanding of these differences and mechanistic underpinnings will help improve procedural strategies and patient outcomes.
- © 2010 by American Heart Association, Inc.