Incidence, predictors, and impact of neurological events in non-ST-segment elevation acute coronary syndromes: The ACUITY trial

ACUITY Trial Investigators

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Aims: We sought to describe the incidence, predictors, and impact of adverse neurological events (NE) in a non-ST-segment elevation acute coronary syndromes (NSTEACS) population undergoing percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or medical therapy (MT). Methods and results: 13,819 patients with moderate and high-risk NSTEACS were enrolled in the prospective ACUITY trial. Angiography was performed within 72 hours of presentation, after which 7,789 patients (56.4%) underwent PCI, 1,539 (11.1%) underwent CABG, and 4,491 (32.5%) received MT. The rate of NE (stroke or transient ischaemic attack) at 30 days and one year and its relationship to adverse ischaemic events, including death, were assessed. Thirty-day rates of NE were 1.1% with CABG, 0.3% with PCI, and 0.5% with MT (p<0.001). One-year rates of NE were 1.1% with CABG, 0.3% with PCI, and 0.6% with MT (p<0.001). Independent predictors of NE at 30 days and one year included age, renal insufficiency, baseline troponin elevation, and initial treatment with CABG. The occurrence of NE was a strong independent predictor of death at 30 days and one year (HR 4.07, 95% CI [1.49, 11.11], p=0.006, and HR 4.25, 95% CI [2.37, 7.62], p<0.001, respectively). Conclusions: In the large-scale ACUITY trial, CABG was associated with a higher risk of NE at 30 days and one year compared to PCI and MT. The occurrence of NE in patients with NSTEACS was strongly associated with increased early and late mortality. Clinical Trials.gov Identifier NCT00093158.

Original languageEnglish (US)
Pages (from-to)399-406
Number of pages8
JournalEuroIntervention
Volume11
Issue number4
DOIs
StatePublished - Aug 1 2015
Externally publishedYes

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Acute Coronary Syndrome
Coronary Artery Bypass
Percutaneous Coronary Intervention
Incidence
Therapeutics
Troponin
Transient Ischemic Attack
Renal Insufficiency
Angiography
Stroke
Clinical Trials
Mortality
Population

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

@article{a6f5277dcfc24d3e82647c1ae537c4ba,
title = "Incidence, predictors, and impact of neurological events in non-ST-segment elevation acute coronary syndromes: The ACUITY trial",
abstract = "Aims: We sought to describe the incidence, predictors, and impact of adverse neurological events (NE) in a non-ST-segment elevation acute coronary syndromes (NSTEACS) population undergoing percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or medical therapy (MT). Methods and results: 13,819 patients with moderate and high-risk NSTEACS were enrolled in the prospective ACUITY trial. Angiography was performed within 72 hours of presentation, after which 7,789 patients (56.4{\%}) underwent PCI, 1,539 (11.1{\%}) underwent CABG, and 4,491 (32.5{\%}) received MT. The rate of NE (stroke or transient ischaemic attack) at 30 days and one year and its relationship to adverse ischaemic events, including death, were assessed. Thirty-day rates of NE were 1.1{\%} with CABG, 0.3{\%} with PCI, and 0.5{\%} with MT (p<0.001). One-year rates of NE were 1.1{\%} with CABG, 0.3{\%} with PCI, and 0.6{\%} with MT (p<0.001). Independent predictors of NE at 30 days and one year included age, renal insufficiency, baseline troponin elevation, and initial treatment with CABG. The occurrence of NE was a strong independent predictor of death at 30 days and one year (HR 4.07, 95{\%} CI [1.49, 11.11], p=0.006, and HR 4.25, 95{\%} CI [2.37, 7.62], p<0.001, respectively). Conclusions: In the large-scale ACUITY trial, CABG was associated with a higher risk of NE at 30 days and one year compared to PCI and MT. The occurrence of NE in patients with NSTEACS was strongly associated with increased early and late mortality. Clinical Trials.gov Identifier NCT00093158.",
author = "{ACUITY Trial Investigators} and Philippe Genereux and Samuel Bernard and Tullio Palmerini and Adriano Caixeta and Gregg Rosner and Reiss, {George R.} and Ke Xu and Roxana Mehran and Stone, {Gregg W.}",
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Incidence, predictors, and impact of neurological events in non-ST-segment elevation acute coronary syndromes : The ACUITY trial. / ACUITY Trial Investigators.

In: EuroIntervention, Vol. 11, No. 4, 01.08.2015, p. 399-406.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Incidence, predictors, and impact of neurological events in non-ST-segment elevation acute coronary syndromes

T2 - The ACUITY trial

AU - ACUITY Trial Investigators

AU - Genereux, Philippe

AU - Bernard, Samuel

AU - Palmerini, Tullio

AU - Caixeta, Adriano

AU - Rosner, Gregg

AU - Reiss, George R.

AU - Xu, Ke

AU - Mehran, Roxana

AU - Stone, Gregg W.

PY - 2015/8/1

Y1 - 2015/8/1

N2 - Aims: We sought to describe the incidence, predictors, and impact of adverse neurological events (NE) in a non-ST-segment elevation acute coronary syndromes (NSTEACS) population undergoing percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or medical therapy (MT). Methods and results: 13,819 patients with moderate and high-risk NSTEACS were enrolled in the prospective ACUITY trial. Angiography was performed within 72 hours of presentation, after which 7,789 patients (56.4%) underwent PCI, 1,539 (11.1%) underwent CABG, and 4,491 (32.5%) received MT. The rate of NE (stroke or transient ischaemic attack) at 30 days and one year and its relationship to adverse ischaemic events, including death, were assessed. Thirty-day rates of NE were 1.1% with CABG, 0.3% with PCI, and 0.5% with MT (p<0.001). One-year rates of NE were 1.1% with CABG, 0.3% with PCI, and 0.6% with MT (p<0.001). Independent predictors of NE at 30 days and one year included age, renal insufficiency, baseline troponin elevation, and initial treatment with CABG. The occurrence of NE was a strong independent predictor of death at 30 days and one year (HR 4.07, 95% CI [1.49, 11.11], p=0.006, and HR 4.25, 95% CI [2.37, 7.62], p<0.001, respectively). Conclusions: In the large-scale ACUITY trial, CABG was associated with a higher risk of NE at 30 days and one year compared to PCI and MT. The occurrence of NE in patients with NSTEACS was strongly associated with increased early and late mortality. Clinical Trials.gov Identifier NCT00093158.

AB - Aims: We sought to describe the incidence, predictors, and impact of adverse neurological events (NE) in a non-ST-segment elevation acute coronary syndromes (NSTEACS) population undergoing percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or medical therapy (MT). Methods and results: 13,819 patients with moderate and high-risk NSTEACS were enrolled in the prospective ACUITY trial. Angiography was performed within 72 hours of presentation, after which 7,789 patients (56.4%) underwent PCI, 1,539 (11.1%) underwent CABG, and 4,491 (32.5%) received MT. The rate of NE (stroke or transient ischaemic attack) at 30 days and one year and its relationship to adverse ischaemic events, including death, were assessed. Thirty-day rates of NE were 1.1% with CABG, 0.3% with PCI, and 0.5% with MT (p<0.001). One-year rates of NE were 1.1% with CABG, 0.3% with PCI, and 0.6% with MT (p<0.001). Independent predictors of NE at 30 days and one year included age, renal insufficiency, baseline troponin elevation, and initial treatment with CABG. The occurrence of NE was a strong independent predictor of death at 30 days and one year (HR 4.07, 95% CI [1.49, 11.11], p=0.006, and HR 4.25, 95% CI [2.37, 7.62], p<0.001, respectively). Conclusions: In the large-scale ACUITY trial, CABG was associated with a higher risk of NE at 30 days and one year compared to PCI and MT. The occurrence of NE in patients with NSTEACS was strongly associated with increased early and late mortality. Clinical Trials.gov Identifier NCT00093158.

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