Abstract 10394: Association Between Angiographic Complications During Percutaneous Coronary Intervention and Clinical Outcomes Among Patients with Acute Coronary Syndrome: An EARLY ACS Angiographic Substudy
Background: Among patients undergoing PCI for NSTEACS, the relationship between intra-procedural complications and clinical outcomes, independent of epicardial and myocardial perfusion, has not been well characterized. The goal of this analysis was to determine the association between intra-procedural complications and clinical outcomes among patients with high-risk NSTEACS undergoing PCI.
Methods and results: EARLY ACS enrolled 9,406 patients with high-risk NSTEACS undergoing an early invasive strategy. Of these, 1,453 underwent PCI, had angiographic assessment in an independent core laboratory and did not have an 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. Of the patients, 166 (11.4%) experienced an intra-procedural 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 intra-procedural complication (28.3% vs. 7.9%, OR 4.64, 95% CI 3.1-6.9, p<0.001). Individually, both mortality (3.0% vs. 0.9%, OR 3.60, 95% CI 1.2-10.5, p=0.019) and MI (27.1%vs. 7.4%, OR 4.66, 95% CI 3.1-7.0, p<0.001) were significantly increased. After adjusting for differences in parameters of epicardial and myocardial perfusion following PCI as well as elevated troponin prior to PCI, the relationship between intra-procedural complications and the composite of death or MI at 30 days remained significant (adjusted OR [ORadj] 3.56, 95% CI 2.2-5.7, p<0.001). The same held true for MI (ORadj 3.58, 95% CI 2.2-5.8, p<0.001) alone, but the difference in mortality alone was directionally similar but no longer statistically significant (ORadj 2.37, 95% CI 0.6-9.0, p=0.20).
Conclusions: Among high-risk NSTEACS patients undergoing an invasive strategy, the incidence of intra-procedural complications is high, and the occurrence of these complications is associated with worse clinical outcomes independent of epicardial and myocardial perfusion.
- © 2011 by American Heart Association, Inc.