Outcomes of patients with acute coronary syndromes and prior percutaneous coronary intervention: a pooled analysis of three randomized clinical trials.
OBJECTIVE
We sought to characterize the outcomes of patients with a prior percutaneous coronary intervention (PCI) who presented with a non-ST-segment elevation acute coronary syndrome (ACS).


RESULTS
We analysed the 30 and 180 day outcomes of 3012 patients with prior PCI and 21 154 patients without prior PCI enrolled in three randomized ACS trials (GUSTO IIb, PURSUIT, and PARAGON-B). The median (25th, 75th percentile) interval between the prior PCI and randomization was 647 (123, 1585) days. Patients with prior PCI had significantly more adverse baseline clinical characteristics, left ventricular dysfunction, and multi-vessel coronary artery disease. After adjusting for baseline characteristics and treatment, we found that patients with prior PCI had a significantly lower mortality rate at 30 days [hazard ratio (HR), 0.60; 95% confidence interval (CI), 0.45-0.80; P=0.0006] and 180 days (HR, 0.81; 95% CI, 0.66-0.98; P=0.029). However, no difference was observed in the composite of death or myocardial infarction (MI) at 30 days (HR, 0.95; 95% CI, 0.83-1.08; P=0.42) or 180 days (HR, 1.01; 95% CI, 0.90-1.13; P=0.90). Patients with prior PCI had a higher rate of MI at 180 days (13.3 vs. 12.0%; P=0.045). Prior-PCI patients had lower incidences of in-hospital cardiogenic shock, congestive heart failure (CHF), and atrial fibrillation.


CONCLUSIONS
Patients with prior PCI who present with non-ST-segment elevation ACS have a lower mortality rate than those without prior PCI.
Labinaz
Marino
M
University of Ottawa Heart Institute, Division of Cardiology, 40 Ruskin Ave, Rm H-150 Ottawa, Ontario, K1Y 4W7 Canada. mlabinaz@ottawaheart.ca
Mathias
Jasmine
J
Pieper
Karen
K
Granger
Christopher B
CB
Lincoff
A Michael
AM
Moliterno
David J
DJ
Van de Werf
Frans
F
Simes
John
J
White
Harvey D
HD
Simoons
Maarten L
ML
Califf
Robert M
RM
Topol
Eric J
EJ
Armstrong
Paul W
PW
Harrington
Robert A
RA
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D019233:Retreatment