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European Heart Journal Advance Access originally published online on December 9, 2004
European Heart Journal 2005 26(2):128-136; doi:10.1093/eurheartj/ehi061
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European Heart Journal vol. 26 no. 2 © The European Society of Cardiology 2004; all rights reserved.

Outcomes of patients with acute coronary syndromes and prior percutaneous coronary intervention: a pooled analysis of three randomized clinical trials

Marino Labinaz1,*, Jasmine Mathias2, Karen Pieper2, Christopher B. Granger2, A. Michael Lincoff3, David J. Moliterno3, Frans Van de Werf4, John Simes5, Harvey D. White6, Maarten L. Simoons7, Robert M. Califf2, Eric J. Topol3, Paul W. Armstrong8 and Robert A. Harrington2

1University of Ottawa Heart Institute, Division of Cardiology, 40 Ruskin Ave, Rm H-150 Ottawa, Ontario, K1Y 4W7 Canada
2Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
3Cleveland Clinic, Cleveland, OH, USA
4University of Leuven, Leuven, Belgium
5University of Sydney, New South Wales, Australia
6Green Lane Hospital, Auckland, New Zealand
7University Hospital, Rotterdam, The Netherlands
8University of Alberta, Edmonton, Alberta, Canada

Received 20 October 2004; revised 8 October 2004; accepted 28 October 2004; online publish-ahead-of-print 9 December 2004.

* Corresponding author. Tel: +1 613 761 5427; fax: +1 613 761 4690. E-mail address: mlabinaz{at}ottawaheart.ca

Aims 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).

Methods and 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.

Conclusion Patients with prior PCI who present with non-ST-segment elevation ACS have a lower mortality rate than those without prior PCI.

Key Words: Percutaneous coronary intervention • Acute coronary syndrome • Myocardial infarction


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