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

• Published in: Archives of cardiovascular diseases 2021-03, Vol.114 (3), p.187-196
• Main Authors: Abtan, Jeremie, Wiviott, Stephen D., Sorbets, Emmanuel, Popovic, Batric, Elbez, Yedid, Mehta, Shamir R., Sabatine, Marc S., Bode, Christoph, Pollack, Charles V., Cohen, Marc, Moccetti, Tiziano, Laanmets, Peep, Faxon, David, Okreglicki, Andrzej, Ducrocq, Gregory, Steg, Ph. Gabriel
• Format: Article
• Language: English
• Subjects: Acute coronary syndrome; Acute Coronary Syndrome - diagnostic imaging; Acute Coronary Syndrome - mortality; Acute Coronary Syndrome - therapy; Aged; Angioplastie coronaire; Anticoagulants - therapeutic use; Complications; 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; Non-ST-segment elevation acute coronary syndrome; Percutaneous coronary intervention; 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; Syndrome coronarien aigu; Time Factors; Treatment Outcome
• ISSN: 1875-2136; 1875-2128
• DOI: 10.1016/j.acvd.2020.09.005

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