Clinical, Invasive and Non-Invasive Factors Affecting Outcomes in Patients with Acute Coronary Syndromes

In this thesis, factors affecting outcomes after percutaneous coronary intervention (PCI), the most common interventional procedure performed, were examined. To constrain procedural costs, selective criteria for drug-eluting stents (DES), which reduce restenosis, were developed in 2003 at Liverpool Hospital, Sydney, Australia. Clinical outcomes were examined in 2075 patients undergoing PCI (29% ≥1 DES and 71% bare metal stent [BMS]); there were no differences between-group (e.g. target vessel revascularization (TVR) rates were 4.9% DES, 6.1% BMS; p=0.288), except for definite stent thrombosis (2% DES, 0.6% BMS; p= 0.002). Selective use criteria for DES achieved low TVR. We examined associations between peri-procedural myocardial infarction (PMI) and late outcomes, in 742 patients. Using the 2007 and 2012 universal definitions of MI, and the Society for Cardiovascular Angiography and Interventions definition, PMI rates varied between 23.2%, 13.3%, and 2.6% respectively (P<0.0001) and the rates of death/MI at 2 years in patients with, compared to those without, PMI were 14.7% and 10.1% (P=0.087), 16.9% and 10.3% (P=0.059) and 29.4% and 10.7% (P=0.015) according to these 3 PMI definitions. To examine prognostic associations between age, gender, and bleeding post-PCI, we determined late events in 3178 consecutive ACS patients. Bleeding was categorized by Bleeding Academic Research Consortium (BARC) criteria, and females had more type 2-5 BARC bleeding post-PCI (p=0.003), higher 3-year mortality rates (p=0.001) though were older (p<0.001). While female patients <55 years (n=988) had higher mortality and bleeding (p=0.028, p=0.001 respectively), there were no differences in patients ≥55 years. While females had more post-PCI bleeding events, which were associated with late mortality, gender was not an independent predictor for mortality. After thrombolytic treatment for MI, a restrictive filling pattern (RFP) had prognostic utility. We studied 218 patients with MI who underwent PCI, and echocardiography within 6 weeks; 16% had RFP. Patients' with RFP had larger cardiac biomarker-assessed infarct sizes (p=0.001). All-cause 5-year mortality, heart failure, and major cardio-vascular events (MACE) were significantly higher in patients with RFP (p =0.004), (p= 0.012) and (p=0.004) respectively. RFP and age were independent predictors for long-term mortality and MACE, confirming their prognostic significance.

Grantor dc:publisher

UNSW, Sydney

Year dc:date

2018

Author dc:creator

• Idris, Hanan

• Peri-procedural myocardial infarction
• Acute Coronary Syndromes
• Percutaneous coronary intervention
• Age, gender, and bleeding post-PCI

Statement dc:rights

• open access
• CC BY-NC-ND 3.0
• free_to_read

Licence

• https://purl.org/coar/access_right/c_abf2
• https://creativecommons.org/licenses/by-nc-nd/3.0/au/

Language dc:language

EN

Identifier

https://doi.org/10.26190/unsworks/20335

OAI identifier oai:identifier

oai:unsworks.library.unsw.edu.au:1959.4/59796