Predictors of adverse events among patients undergoing primary percutaneous coronary intervention: insights from a pooled analysis of the COMFORTABLE AN and EX AMIfATHON trials
Por:
Taniwaki, M, Stefanini, GG, Raber, L, Brugaletta, S, Cequier, A, Heg, D, Iniguez, A, Kelbaek, H, Serra, A, Ostoijic, M, Hernandez-Antolin, R, Baumbach, A, Blochlinger, S, Juni, P, Mainar, V, Sabate, M, Windecker, S
Publicada:
1 ago 2015
Resumen:
Aims: The aim of this study was to identify predictors of adverse events among patients with ST-elevation myocardial infarction (STEMI) undergoing contemporary primary percutaneous coronary intervention (PCI).
Methods and results: Individual data of 2,655 patients from two primary PCI trials (EXAMINATION, N=1,504; COMFORTABLE AMI, N=1,161) with identical endpoint defmitions and event adjudication were pooled. Predictors of all-cause death or any reinfarction and definite stent thrombosis (ST) and target lesion revascularisation (TLR) outcomes at one year were identified by multivariable Cox regression analysis. Killip class III or IV was the strongest predictor of all-cause death or any reinfarction (OR 5.11, 95% CI: 2.48-10.52), definite ST (OR 7.74, 95% CI: 2.87-20.93), and TLR (OR 2.88, 95% CI: 1.17-7.06). Impaired left ventricular ejection fraction (OR 4.77, 95% CI: 2.10-10.82), final TIMI flow 0-2 (OR 1.93, 95% CI: 1.053.54), arterial hypertension (OR 1.69, 95% CI: 1.11-2.59), age (OR 1.68, 95% CI: 1.41-2.01), and peak CK (OR 1.25, 95% CI: 1.02-1.54) were independent predictors of all-cause death or any reinfarction. Allocation to treatment with DES was an independent predictor of a lower risk of definite ST (OR 0.35, 95% CI: 0.160.74) and any TLR (OR 0.34, 95% CI: 0.21-0.54).
Conclusions: Killip class remains the strongest predictor of all-cause death or any reinfarction among STEMI patients undergoing primary PCI. DES use independently predicts a lower risk of TLR and definite ST compared with BMS. The COMFORTABLE AMI trial is registered at: http://www.clinicaltrials.gov/ ct2/show/NCT00962416. The EXAMINATION trial is registered at: http://www.clinicaltrials.govict2/show/ NCT00828087
Filiaciones:
Taniwaki, M:
Univ Hosp Bern, Dept Cardiol, CH-3010 Bern, Switzerland
Stefanini, GG:
Univ Hosp Bern, Dept Cardiol, CH-3010 Bern, Switzerland
Raber, L:
Univ Hosp Bern, Dept Cardiol, CH-3010 Bern, Switzerland
Brugaletta, S:
Univ Hosp Clin, Dept Cardiol, Barcelona, Spain
Cequier, A:
Univ Hosp Bellvitge, Inst Heart, Barcelona, Spain
Heg, D:
Univ Bern, Dept Clin Res, Bern, Switzerland
Iniguez, A:
Hosp Meixoeiro, Vigo, Spain
Kelbaek, H:
Rigshosp, Cardiac Catheterizat Lab, DK-2100 Copenhagen, Denmark
Serra, A:
Univ Hosp St Pau, Barcelona, Spain
Ostoijic, M:
Clin Ctr Serbia, Dept Cardiol, Belgrade, Serbia
Hernandez-Antolin, R:
Univ Hosp San Carlos, Dept Cardiol, Madrid, Spain
Baumbach, A:
Bristol Heart Inst, Dept Cardiol, Bristol, Avon, England
Blochlinger, S:
Univ Hosp Bern, Dept Cardiol, CH-3010 Bern, Switzerland
Juni, P:
Univ Bern, Dept Clin Res, Bern, Switzerland
Mainar, V:
Hosp Gen Alicante, Dept Cardiol, Alicante, Spain
Sabate, M:
Univ Hosp Clin, Dept Cardiol, Barcelona, Spain
Windecker, S:
Univ Hosp Bern, Dept Cardiol, CH-3010 Bern, Switzerland
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