Prognostic value of angiographic lesion complexity in patients with acute coronary syndromes undergoing percutaneous coronary intervention (from the acute catheterization and urgent intervention triage strategy trial).

Abstract

Although lesion complexity is predictive of outcomes after balloon angioplasty, it is unclear whether complex lesions continue to portend a worse prognosis in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) with contemporary interventional therapies. We sought to assess the impact of angiographic lesion complexity, defined by the modified American College of Cardiology/American Heart Association classification, on clinical outcomes after PCI in patients with ACS and to determine whether an interaction exists between lesion complexity and antithrombin regimen outcomes after PCI. Among the 3,661 patients who underwent PCI in the Acute Catheterization and Urgent Intervention Triage strategy study, patients with type C lesions (n = 1,654 [45%]) had higher 30-day rates of mortality (1.2% vs 0.6%, p = 0.049), myocardial infarction (9.2% vs 6.3%, p = 0.0006), and unplanned revascularization (4.3% vs 3.1%, p = 0.04) compared with those without type C lesions. In multivariate analysis, type C lesions were independently associated with myocardial infarction (odds ratio [95% confidence interval] = 1.37 [1.04 to 1.80], p = 0.02) and composite ischemia (odds ratio [95% confidence interval] = 1.49 [1.17 to 1.88], p = 0.001) at 30 days. Bivalirudin monotherapy compared with heparin plus a glycoprotein IIb/IIIa inhibitor reduced major bleeding complications with similar rates of composite ischemic events, regardless of the presence of type C lesions. There were no interactions between antithrombotic regimens and lesion complexity in terms of composite ischemia and major bleeding (p [interaction] = 0.91 and 0.80, respectively). In conclusion, patients with ACS with type C lesion characteristics undergoing PCI have an adverse short-term prognosis. Treatment with bivalirudin monotherapy reduces major hemorrhagic complications irrespective of lesion complexity with comparable suppression of adverse ischemic events as heparin plus glycoprotein IIb/IIIa inhibitor.

• Authors: Kenji Goto, Alexandra J Lansky, Vivian G Ng, Cody Pietras, Erol Nargileci, Roxana Mehran, Helen Parise, Frederick Feit, E Magnus Ohman, Harvey D White, Michel E Bertrand, Walter Desmet, Martial Hamon, Gregg W Stone
• Journal: The American journal of cardiology (Am J Cardiol) Vol. 114 Issue 11 Pg. 1638-45 (Dec 01 2014) ISSN: 1879-1913 [Electronic] United States
• PMID: 25312637 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 Elsevier Inc. All rights reserved.

Chemical References

• Anticoagulants
• Hirudins
• Peptide Fragments
• Platelet Aggregation Inhibitors
• Platelet Glycoprotein GPIIb-IIIa Complex
• Recombinant Proteins
• Heparin
• bivalirudin

Topics

• Acute Coronary Syndrome (mortality, therapy)
• Aged
• Anticoagulants (therapeutic use)
• Coronary Angiography
• Coronary Artery Disease (diagnostic imaging, mortality, therapy)
• Female
• Hemorrhage (chemically induced)
• Heparin (therapeutic use)
• Hirudins
• Humans
• Male
• Middle Aged
• Multivariate Analysis
• Myocardial Infarction (mortality, prevention & control)
• Myocardial Revascularization (statistics & numerical data)
• Odds Ratio
• Peptide Fragments (therapeutic use)
• Percutaneous Coronary Intervention
• Platelet Aggregation Inhibitors (therapeutic use)
• Platelet Glycoprotein GPIIb-IIIa Complex (antagonists & inhibitors)
• Prognosis
• Recombinant Proteins (therapeutic use)
• Severity of Illness Index
• Treatment Outcome