Prevalence, clinical determinants and prognostic implications of coronary procedural complications of percutaneous coronary intervention in non-ST-segment elevation myocardial infarction: Insights from the contemporary multinational TAO trial

Arch Cardiovasc Dis. 2021 Mar;114(3):187-196. doi: 10.1016/j.acvd.2020.09.005. Epub 2021 Jan 29.

Abstract

Background: Few data are available on procedural complications of percutaneous coronary intervention (PCI) in the setting of acute coronary syndrome in the contemporary era.

Aim: We sought to describe the prevalence of procedural complications of PCI in a non-ST-segment elevation acute coronary syndrome (NSTE ACS) cohort, and to identify their clinical characteristics and association with clinical outcomes.

Methods: Patients randomized in TAO (Treatment of Acute coronary syndrome with Otamixaban), an international randomized controlled trial (ClinicalTrials.gov Identifier: NCT01076764) that compared otamixaban with unfractionated heparin plus eptifibatide in patients with NSTE ACS who underwent PCI, were included in the analysis. Procedural complications were collected prospectively, categorized and adjudicated by a blinded Clinical Events Committee, with review of angiograms. A multivariable model was constructed to identify independent clinical characteristics associated with procedural complications.

Results: A total of 8656 patients with NSTE ACS who were enrolled in the TAO trial underwent PCI, and 451 (5.2%) experienced at least one complication. The most frequent complications were no/slow reflow (1.5%) and dissection with decreased flow (1.2%). Procedural complications were associated with the 7-day ischaemic outcome of death, myocardial infarction or stroke (24.2% vs. 6.0%, odds ratio 5.01, 95% confidence interval 3.96-6.33; P<0.0001) and with Thrombolysis In Myocardial Infarction major and minor bleeding (6.2% vs. 2.3%, odds ratio 2.79, 95% confidence interval 1.86-4.2; P<0.0001). Except for previous coronary artery bypass grafting, multivariable analysis did not identify preprocedural clinical predictors of complications.

Conclusions: In a contemporary NSTE ACS population, procedural complications with PCI remain frequent, are difficult to predict based on clinical characteristics, and are associated with worse ischaemic and haemorrhagic outcomes.

Keywords: Acute coronary syndrome; Angioplastie coronaire; Complications; Non-ST-segment elevation acute coronary syndrome; Percutaneous coronary intervention; Syndrome coronarien aigu.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Acute Coronary Syndrome / diagnostic imaging
  • Acute Coronary Syndrome / mortality
  • Acute Coronary Syndrome / therapy*
  • Aged
  • Anticoagulants / therapeutic use
  • Cyclic N-Oxides / therapeutic use
  • Databases, Factual
  • Eptifibatide / therapeutic use
  • Factor Xa Inhibitors / therapeutic use
  • Female
  • Hemorrhage / epidemiology*
  • Hemorrhage / mortality
  • Heparin / therapeutic use
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • No-Reflow Phenomenon / epidemiology*
  • No-Reflow Phenomenon / mortality
  • Non-ST Elevated Myocardial Infarction / diagnostic imaging
  • Non-ST Elevated Myocardial Infarction / mortality
  • Non-ST Elevated Myocardial Infarction / therapy*
  • Percutaneous Coronary Intervention / adverse effects*
  • Percutaneous Coronary Intervention / mortality
  • Platelet Aggregation Inhibitors / therapeutic use
  • Prevalence
  • Pyridines / therapeutic use
  • Randomized Controlled Trials as Topic
  • Recurrence
  • Risk Assessment
  • Risk Factors
  • Stroke / epidemiology*
  • Stroke / mortality
  • Time Factors
  • Treatment Outcome

Substances

  • Anticoagulants
  • Cyclic N-Oxides
  • Factor Xa Inhibitors
  • Platelet Aggregation Inhibitors
  • Pyridines
  • Heparin
  • Eptifibatide
  • otamixaban

Associated data

  • ClinicalTrials.gov/NCT01076764