Abstract 11526: Intraprocedural Thrombotic Events During PCI for ACS Are Associated With Increased Adverse Ischemic Events at 30 Days: A Meta-Analysis of Randomized Trials
Background: Data regarding intraprocedural thrombotic events (IPTE) including slow reflow or no reflow, distal embolization, intraprocedural stent thrombosis and abrupt vessel closure during PCI for acute coronary syndrome (ACS) are scarce. Their association with subsequent adverse ischemic events needs further investigation.
Aim: To evaluate effect of IPTE on in-hospital and at 30-days clinical outcomes after PCI for ACS.
Hypothesis: IPTE during PCI are associated with adverse ischemic events while in-hospital and at 30 days.
Methods: We performed a literature search of all published full-length articles of randomized trials that reported data on patients with IPTE compared with no IPTE during PCI for patients with ACS. We calculated odd ratios via random effects model for in-hospital ischemic outcomes and 30 day outcomes.
Results: Our literature search yielded 3 randomized trials reporting clinical outcomes with IPTE and no IPTE for ACS patients undergoing PCI: ACUITY, HORIZONS-AMI and EARLY-ACS trials. We report clinical outcomes (in-hospital and at 30 days) in 8,043 patients in total, of those 673 had IPTE. At 30 days, patients with IPTE had more major adverse cardiovascular events (MACE) (Odds ratio (OR) 3.97, 95% Confidence interval (CI) [1.81-8.69]; p=0.0006), mortality (OR 4.54, 95% CI [1.99, 10.39]; p=0.0003), myocardial infarction (OR 4.54, 95% CI [1.99, 10.39]; p=0.0003), repeat revascularization (OR 4.54, 95% CI [1.99, 10.39]; p=0.0003), total stent thrombosis (OR 4.54, 95% CI [1.99, 10.39]; p=0.0003) and non-CABG related major bleeding (OR 4.54, 95% CI [1.99, 10.39]; p=0.0003) than those with no IPTE. Similarly, in-hospital clinical outcomes were all significantly higher in patients with IPTE than those without.
Conclusion: IPTE during PCI is associated with more adverse ischemic events, including mortality, both in-hospital and at 30 days.
Author Disclosures: R. Nairooz: None. P. Sardar: None. S. Chatterjee: None. Z. Ahmed: None. D.N. Feldman: Speakers Bureau; Modest; Eli Lilly, Daiichi-Sankyo, Pfizer, Abbott Vascular, Bristol-Myers Squibb.
- © 2014 by American Heart Association, Inc.