Twelve-month clinical outcomes in patients with acute coronary syndrome undergoing complex percutaneous coronary
J J Coughlan1,2, Alp Aytekin1, Gjin Ndrepepa1
1Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, 80636 Munich, Germany.
Insights
Complex percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) patients increases ischemic event risk. This analysis found higher rates of death, myocardial infarction, or stroke after complex PCI compared to non-complex PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- Complex percutaneous coronary intervention (PCI) is linked to increased ischemic events.
- Contemporary data on complex PCI outcomes in acute coronary syndrome (ACS) patients on potent P2Y12 inhibitors is limited.
- The ISAR-REACT 5 trial provides a relevant cohort for this analysis.
Purpose of the Study:
- To analyze the impact of complex PCI on ischemic and bleeding events in ACS patients treated with potent P2Y12 inhibitors.
- To compare outcomes between complex and non-complex PCI in a contemporary ACS population.
- To evaluate the safety and efficacy of PCI strategies in high-risk ACS patients.
Main Methods:
- Analysis of ACS patients from the ISAR-REACT 5 trial undergoing PCI.
- Definition of complex PCI: multi-vessel PCI, ≥3 stents, ≥3 lesions treated, or total stented length >60 mm.
- Primary endpoint: composite of all-cause death, myocardial infarction (MI), or stroke at 12 months. Safety endpoint: Bleeding Academic Research Consortium types 3-5 bleeding at 12 months.
Main Results:
- 1429 patients had complex PCI, and 1948 had non-complex PCI.
- The primary endpoint occurred more frequently in the complex PCI group (10.1% vs. 7.2%, HR 1.44, P=0.002), driven by a higher MI risk (HR 1.62, P=0.004).
- No significant difference in major bleeding events between groups (6.7% vs. 5.3%, HR 1.28, P=0.08), though numerically higher in complex PCI.
Conclusions:
- ACS patients undergoing complex PCI face a higher risk of ischemic events.
- Complex PCI in ACS patients requires careful consideration due to increased MI risk.
- Potent P2Y12 inhibitor therapy did not mitigate the increased ischemic risk associated with complex PCI.
Aims:
Complex percutaneous coronary intervention (PCI) is associated with a higher risk of ischaemic events. However, no study has analysed the effect of PCI complexity on outcomes in a contemporary cohort of acute coronary syndrome (ACS) patients treated with a dual anti-platelet therapy regimen based on potent P2Y12-inhibitors. Therefore, we performed the current analysis.
Methods And Results:
This analysis included all ACS patients treated with PCI in the Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment (ISAR-REACT) 5 trial. Complex PCI was defined as at least one of: multi-vessel PCI, ≥3 stents implanted, ≥3 lesions treated, and total stented length >60 mm. The primary endpoint was the composite of all-cause death, myocardial infarction (MI), or stroke at 12 months; the safety endpoint was Bleeding Academic Research Consortium types 3-5 bleeding at 12 months. Overall, 3377 patients were included in this analysis (complex PCI, n = 1429; non-complex PCI, n = 1948). The primary endpoint occurred more frequently in the complex PCI group than the non-complex PCI group [10.1% vs. 7.2%, hazard ratio (HR): 1.44, 95% confidence interval (CI) (1.14-1.82), P = 0.002], driven primarily by a higher risk of MI [HR: 1.62, (1.17-2.26), P = 0.004]. The safety endpoint was not statistically different between patients undergoing complex vs. non-complex PCI, although it was numerically higher in the complex PCI group [6.7% vs. 5.3%, HR: 1.28, (0.97-1.70), P = 0.08].
Conclusions:
Acute coronary syndrome patients undergoing complex PCI have an increased incidence of ischaemic events compared with ACS patients undergoing non-complex PCI.
Clinical Trial Registration:
NCT01944800, Prospective, Randomized Trial of Ticagrelor Vs. Prasugrel in Patients With Acute Coronary Syndrome-Full-Text View-ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT01944800.
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