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European Heart Journal Advance Access published online on December 9, 2004
European Heart Journal, doi:10.1093/eurheartj/ehi061
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European Heart Journal © The European Society of Cardiology 2004; all rights reserved.

Clinical research

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

Marino Labinaz 1*, Jasmine Mathias 2, Karen Pieper 2, Christopher B. Granger 2, A. Michael Lincoff 3, David J. Moliterno 3, Frans Van de Werf 4, John Simes 5, Harvey D. White 6, Maarten L. Simoons 7, Robert M. Califf 2, Eric J. Topol 3, Paul W. Armstrong 8, and Robert A. Harrington 2

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

* To whom correspondence should be addressed.
Marino Labinaz, E-mail: mlabinaz{at}ottawaheart.ca


  Abstract

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.

Keywords: Percutaneous coronary intervention; Acute coronary syndrome; Myocardial infarction.
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