Which intraprocedural thrombotic events impact clinical outcomes after percutaneous coronary intervention in acute coronary syndromes? A pooled analysis of the HORIZONS-AMI and ACUITY trials

Jeffrey D. Wessler, Philippe Genereux, Roxana Mehran, Girma Minalu Ayele, Sorin J. Brener, Margaret McEntegart, Ori Ben-Yehuda, Gregg W. Stone, Ajay J. Kirtane

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objectives This study sought to determine the extent to which individual components of intraprocedural thrombotic events (IPTEs) are associated with adverse events. Background IPTEs occurring during percutaneous coronary intervention (PCI) are associated with adverse in-hospital and late outcomes in patients with acute coronary syndromes. Methods A total of 6,591 patients who underwent PCI for non-ST-segment elevation acute coronary syndromes/ST-segment elevation myocardial infarction in the ACUITY (Acute Catheterization and Urgent Intervention Triage StrategY) and HORIZONS-AMI (Harmonizing Outcomes with RevascularIZatiON and Stents in Acute Myocardial Infarction) trials underwent detailed frame-by-frame core laboratory angiographic analysis to assess for IPTEs. The associations of IPTE components with death, major bleeding, and major adverse cardiac events at 30 days were assessed using univariable analyses and multivariable models. Results The overall incidence of IPTEs was 7.7%, with a greater incidence in ST-segment elevation myocardial infarction patients (12.2%) compared with non-ST-segment elevation acute coronary syndromes patients (3.5%). Specific components of IPTEs included no-reflow/slow reflow in 58.0%, new/worsened thrombus in 35.3%, distal embolization in 34.9%, abrupt closure in 19.8%, and intraprocedural stent thrombosis (IPST) in 9.5% of patients. Each IPTE component was independently associated with 30-day death, major bleeding, and MACE in multivariable models, with the strongest association observed for IPST (MACE hazard ratio: 7.51 [95% confidence interval: 4.36 to 12.94]). Conclusions The occurrence of IPTEs is not infrequent among high-risk acute coronary syndromes patients undergoing PCI, and each IPTE component was associated with subsequent adverse events. Although IPST represented <10% of IPTE events overall, it was the component with the strongest association with adverse events.

Original languageEnglish (US)
Pages (from-to)331-337
Number of pages7
JournalJACC: Cardiovascular Interventions
Volume9
Issue number4
DOIs
StatePublished - Feb 22 2016
Externally publishedYes

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Triage
Percutaneous Coronary Intervention
Acute Coronary Syndrome
Catheterization
Stents
Myocardial Infarction
Thrombosis
Hemorrhage
Incidence
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Wessler, Jeffrey D. ; Genereux, Philippe ; Mehran, Roxana ; Ayele, Girma Minalu ; Brener, Sorin J. ; McEntegart, Margaret ; Ben-Yehuda, Ori ; Stone, Gregg W. ; Kirtane, Ajay J. / Which intraprocedural thrombotic events impact clinical outcomes after percutaneous coronary intervention in acute coronary syndromes? A pooled analysis of the HORIZONS-AMI and ACUITY trials. In: JACC: Cardiovascular Interventions. 2016 ; Vol. 9, No. 4. pp. 331-337.
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title = "Which intraprocedural thrombotic events impact clinical outcomes after percutaneous coronary intervention in acute coronary syndromes? A pooled analysis of the HORIZONS-AMI and ACUITY trials",
abstract = "Objectives This study sought to determine the extent to which individual components of intraprocedural thrombotic events (IPTEs) are associated with adverse events. Background IPTEs occurring during percutaneous coronary intervention (PCI) are associated with adverse in-hospital and late outcomes in patients with acute coronary syndromes. Methods A total of 6,591 patients who underwent PCI for non-ST-segment elevation acute coronary syndromes/ST-segment elevation myocardial infarction in the ACUITY (Acute Catheterization and Urgent Intervention Triage StrategY) and HORIZONS-AMI (Harmonizing Outcomes with RevascularIZatiON and Stents in Acute Myocardial Infarction) trials underwent detailed frame-by-frame core laboratory angiographic analysis to assess for IPTEs. The associations of IPTE components with death, major bleeding, and major adverse cardiac events at 30 days were assessed using univariable analyses and multivariable models. Results The overall incidence of IPTEs was 7.7{\%}, with a greater incidence in ST-segment elevation myocardial infarction patients (12.2{\%}) compared with non-ST-segment elevation acute coronary syndromes patients (3.5{\%}). Specific components of IPTEs included no-reflow/slow reflow in 58.0{\%}, new/worsened thrombus in 35.3{\%}, distal embolization in 34.9{\%}, abrupt closure in 19.8{\%}, and intraprocedural stent thrombosis (IPST) in 9.5{\%} of patients. Each IPTE component was independently associated with 30-day death, major bleeding, and MACE in multivariable models, with the strongest association observed for IPST (MACE hazard ratio: 7.51 [95{\%} confidence interval: 4.36 to 12.94]). Conclusions The occurrence of IPTEs is not infrequent among high-risk acute coronary syndromes patients undergoing PCI, and each IPTE component was associated with subsequent adverse events. Although IPST represented <10{\%} of IPTE events overall, it was the component with the strongest association with adverse events.",
author = "Wessler, {Jeffrey D.} and Philippe Genereux and Roxana Mehran and Ayele, {Girma Minalu} and Brener, {Sorin J.} and Margaret McEntegart and Ori Ben-Yehuda and Stone, {Gregg W.} and Kirtane, {Ajay J.}",
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Which intraprocedural thrombotic events impact clinical outcomes after percutaneous coronary intervention in acute coronary syndromes? A pooled analysis of the HORIZONS-AMI and ACUITY trials. / Wessler, Jeffrey D.; Genereux, Philippe; Mehran, Roxana; Ayele, Girma Minalu; Brener, Sorin J.; McEntegart, Margaret; Ben-Yehuda, Ori; Stone, Gregg W.; Kirtane, Ajay J.

In: JACC: Cardiovascular Interventions, Vol. 9, No. 4, 22.02.2016, p. 331-337.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Which intraprocedural thrombotic events impact clinical outcomes after percutaneous coronary intervention in acute coronary syndromes? A pooled analysis of the HORIZONS-AMI and ACUITY trials

AU - Wessler, Jeffrey D.

AU - Genereux, Philippe

AU - Mehran, Roxana

AU - Ayele, Girma Minalu

AU - Brener, Sorin J.

AU - McEntegart, Margaret

AU - Ben-Yehuda, Ori

AU - Stone, Gregg W.

AU - Kirtane, Ajay J.

PY - 2016/2/22

Y1 - 2016/2/22

N2 - Objectives This study sought to determine the extent to which individual components of intraprocedural thrombotic events (IPTEs) are associated with adverse events. Background IPTEs occurring during percutaneous coronary intervention (PCI) are associated with adverse in-hospital and late outcomes in patients with acute coronary syndromes. Methods A total of 6,591 patients who underwent PCI for non-ST-segment elevation acute coronary syndromes/ST-segment elevation myocardial infarction in the ACUITY (Acute Catheterization and Urgent Intervention Triage StrategY) and HORIZONS-AMI (Harmonizing Outcomes with RevascularIZatiON and Stents in Acute Myocardial Infarction) trials underwent detailed frame-by-frame core laboratory angiographic analysis to assess for IPTEs. The associations of IPTE components with death, major bleeding, and major adverse cardiac events at 30 days were assessed using univariable analyses and multivariable models. Results The overall incidence of IPTEs was 7.7%, with a greater incidence in ST-segment elevation myocardial infarction patients (12.2%) compared with non-ST-segment elevation acute coronary syndromes patients (3.5%). Specific components of IPTEs included no-reflow/slow reflow in 58.0%, new/worsened thrombus in 35.3%, distal embolization in 34.9%, abrupt closure in 19.8%, and intraprocedural stent thrombosis (IPST) in 9.5% of patients. Each IPTE component was independently associated with 30-day death, major bleeding, and MACE in multivariable models, with the strongest association observed for IPST (MACE hazard ratio: 7.51 [95% confidence interval: 4.36 to 12.94]). Conclusions The occurrence of IPTEs is not infrequent among high-risk acute coronary syndromes patients undergoing PCI, and each IPTE component was associated with subsequent adverse events. Although IPST represented <10% of IPTE events overall, it was the component with the strongest association with adverse events.

AB - Objectives This study sought to determine the extent to which individual components of intraprocedural thrombotic events (IPTEs) are associated with adverse events. Background IPTEs occurring during percutaneous coronary intervention (PCI) are associated with adverse in-hospital and late outcomes in patients with acute coronary syndromes. Methods A total of 6,591 patients who underwent PCI for non-ST-segment elevation acute coronary syndromes/ST-segment elevation myocardial infarction in the ACUITY (Acute Catheterization and Urgent Intervention Triage StrategY) and HORIZONS-AMI (Harmonizing Outcomes with RevascularIZatiON and Stents in Acute Myocardial Infarction) trials underwent detailed frame-by-frame core laboratory angiographic analysis to assess for IPTEs. The associations of IPTE components with death, major bleeding, and major adverse cardiac events at 30 days were assessed using univariable analyses and multivariable models. Results The overall incidence of IPTEs was 7.7%, with a greater incidence in ST-segment elevation myocardial infarction patients (12.2%) compared with non-ST-segment elevation acute coronary syndromes patients (3.5%). Specific components of IPTEs included no-reflow/slow reflow in 58.0%, new/worsened thrombus in 35.3%, distal embolization in 34.9%, abrupt closure in 19.8%, and intraprocedural stent thrombosis (IPST) in 9.5% of patients. Each IPTE component was independently associated with 30-day death, major bleeding, and MACE in multivariable models, with the strongest association observed for IPST (MACE hazard ratio: 7.51 [95% confidence interval: 4.36 to 12.94]). Conclusions The occurrence of IPTEs is not infrequent among high-risk acute coronary syndromes patients undergoing PCI, and each IPTE component was associated with subsequent adverse events. Although IPST represented <10% of IPTE events overall, it was the component with the strongest association with adverse events.

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