TCT-216 Predictors Of Patient-Oriented And Device-Oriented Outcomes Among Patients Undergoing Primary Percutaneous Coronary Intervention

Abstract

Background: Treatment of STEMI has considerably evolved over the past 2 decades. However, predictors of adverse events after STEMI are mostly based on early studies without consistent use of reperfusion therapy, P2Y12 inhibitors, and drug-eluting stent implantation. We aimed to identify predictors of adverse events among patients with ST-elevation myocardial infarction (STEMI) undergoing contemporary primary percutaneous coronary intervention (PCI). Methods: Individual data of 2655 patients from 2 primary PCI trials (EXAMINATION, N=1504; COMFORTABLE-AMI, N=1161) with identical endpoint definition and event adjudication were pooled. Predictors of patient-oriented (death or reinfarction) and device-oriented (definite stent thrombosis [ST] and target-lesion revascularization [TLR]) outcomes at 1 year were identified by multivariable Cox regressions analysis. Results: Killip class III/IV was the strongest predictor of death or reinfarction (OR5.11, 95%CI2.48-10.52), ST (OR7.74, 95%CI2.87-20.93), and any TLR (OR2.88, 95%CI1.17-7.06). Impaired LVEF (OR4.77, 95%CI2.10-10.82), final TIMI flow 0-2 (OR1.93, 95%CI1.05-3.54), hypertension (OR1.69, 95%CI1.11-2.59), age (OR1.68, 95%CI1.41-2.01), and peak CK (OR1.25, 95%CI1.02-1.54) were independent predictors of death or reinfarction. Allocation to treatment with DES was an independent predictor of a lower risk of ST (OR0.35, 95%CI0.16-0.74) and any TLR (OR0.34, 95%CI0.21-0.54). Conclusions: Killip class remains the strongest predictor of death or reinfarction among STEMI patients undergoing primary PCI. Noteworthy, DES use independently predicts a lower risk of TLR and definite ST.