Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
JACC Cardiovasc Interv. 2012 Sep;5(9):927-35. doi: 10.1016/j.jcin.2012.05.007.
The goal of this analysis was to determine the association between intraprocedural complications and clinical outcomes among patients with high-risk non-ST-segment elevation acute coronary syndrome (NSTEACS) undergoing percutaneous coronary intervention (PCI).
Among patients undergoing PCI for NSTEACS, the relationship between intraprocedural complications and clinical outcomes, independent of epicardial and myocardial perfusion, has not been well characterized.
The EARLY ACS (Early Glycoprotein IIb/IIIa Inhibition in Non-ST-Segment Elevation Acute Coronary Syndrome) trial enrolled 9,406 patients with high-risk NSTEACS undergoing an early invasive strategy. Of these, 1,452 underwent angiographic assessment in an independent core laboratory and did not have a myocardial infarction (MI) between enrollment and angiography. We assessed the relationship between abrupt closure, loss of side branch(es), distal embolization, and no-reflow phenomenon and 30-day clinical outcomes in these patients.
Of the patients, 166 (11.4%) experienced an intraprocedural complication. Baseline clinical characteristics were similar between patients who did and did not have complications. The 30-day composite of death or MI was significantly higher among patients with an intraprocedural complication (28.3% vs. 7.8%, odds ratio [OR]: 4.68, 95% confidence interval [CI]: 3.2 to 7.0, p < 0.001). Individually, both mortality (3.0% vs. 0.9%, OR: 3.60, 95% CI: 1.2 to 10.5, p = 0.019) and MI (27.1% vs. 7.4%, OR: 4.66, 95% CI: 3.1 to 7.0, p < 0.001) were significantly increased. After adjusting for differences in post-PCI epicardial and myocardial perfusion, the association with 30-day death or MI remained significant.
Among high-risk NSTEACS patients undergoing an invasive strategy, the incidence of intraprocedural complications is high, and the occurrence of these complications is associated with worse clinical outcomes independent of epicardial and myocardial perfusion. (Early Glycoprotein IIb/IIIa Inhibition in Patients With Non-ST-segment Elevation Acute Coronary Syndrome [EARLY ACS]; NCT00089895).
本分析旨在确定行经皮冠状动脉介入治疗（PCI）的高危非 ST 段抬高型急性冠状动脉综合征（NSTEACS）患者术中并发症与临床结局之间的关联。
在接受 PCI 治疗的 NSTEACS 患者中，尚未充分描述术中并发症与临床结局之间的关系，而不考虑心外膜和心肌灌注情况。
EARLY ACS（早期非 ST 段抬高型急性冠状动脉综合征中糖蛋白 IIb/IIIa 抑制剂）试验纳入了 9406 例接受早期有创策略治疗的高危 NSTEACS 患者。其中，1452 例在独立的核心实验室进行了血管造影评估，且在入组和血管造影之间未发生心肌梗死（MI）。我们评估了这些患者术中出现的突然闭塞、分支丢失、远端栓塞和无复流现象与 30 天临床结局之间的关系。
在这些患者中，166 例（11.4%）发生术中并发症。有和无术中并发症的患者的基线临床特征相似。发生术中并发症的患者 30 天复合终点（死亡或 MI）发生率显著更高（28.3% vs. 7.8%，比值比[OR]：4.68，95%置信区间[CI]：3.2 至 7.0，p < 0.001）。单独来看，死亡率（3.0% vs. 0.9%，OR：3.60，95%CI：1.2 至 10.5，p = 0.019）和 MI（27.1% vs. 7.4%，OR：4.66，95%CI：3.1 至 7.0，p < 0.001）也显著增加。在调整 PCI 后心外膜和心肌灌注差异后，与 30 天死亡或 MI 的关联仍然显著。
在接受有创策略治疗的高危 NSTEACS 患者中，术中并发症发生率较高，且这些并发症的发生与心外膜和心肌灌注无关的临床结局较差相关。（非 ST 段抬高型急性冠状动脉综合征患者中的早期糖蛋白 IIb/IIIa 抑制剂[EARLY ACS]；NCT00089895）。
