Predictors of outcome in patients undergoing PCI.: Results of the RIVIERA study

被引:60
作者
Montalescot, Gilles [1 ]
Ongen, Zeki [2 ]
Guindy, Ramez [3 ]
Sousa, Amanda [4 ]
Lu, Shu-Zheng [5 ]
Pahlajani, Dev [6 ]
Pellois, Andre [7 ]
Vicaut, Eric [8 ]
机构
[1] Hop La Pitie Salpetriere, Inst Cardiol, Paris, France
[2] Istanbul Univ, Cerrahpasa Med Fac, Istanbul, Turkey
[3] Cairo Special Hosp, Cairo, Egypt
[4] Inst Dante Pazzanese Cardiol, Sao Paulo, Brazil
[5] Beijing Anzhen Hosp, Beijing, Peoples R China
[6] Breach Candy Hosp, Bombay, Maharashtra, India
[7] Sanofi Aventis, Paris, France
[8] Hop Lariboisiere, Unite Rech Clin, F-75475 Paris, France
关键词
angiographic complications; angioplasty; myocardial infarction;
D O I
10.1016/j.ijcard.2007.07.127
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Limited information is available about clinical outcomes following routine percutaneous coronary intervention (PCI) in the current era. This study aimed to identify predictors of adverse clinical or angiographic complications following PCI in patients from many different countries. Methods: RIVIERA is a multinational, prospective, observational study in patients undergoing elective or primary PCI. Consecutive patients (n= 7962) were enrolled in 144 hospitals from 23 countries in four different continents. Primary outcome was death or myocardial infarction (MI). The mean age of the patients was 59 years and 77% were men; 92% of patients underwent elective and 8% primary PCI. Results: The rate of in-hospital outcomes was low: death 0.3%, MI 1%, any bleeding 3.4%. Angiographic complications occurred in 8.7% of patients, mainly coronary dissection (3.7%) and no reflow (2%). After multivariable analysis, the strongest independent predictors of death or MI were clinical presentation with non-ST-segment elevation acute coronary syndrome or ST-segment elevation myocardial infarction and administration of a glycoprotein (GP) IIb/IIIa inhibitor. Radial access, thienopyridine pretreatment and anticoagulation with enoxaparin were associated with a lower risk of death or MI. Female gender, PCI of coronary artery bypass graft, administration of a GP IIb/IIIa inhibitor and combined use of enoxaparin and unfractionated heparin were significantly associated with more bleeding. Radial access was the only variable associated with less bleeding. Conclusions: Routine PCI appears to be a relatively safe revascularization procedure. Many of the variables identified as predictors of adverse cardiac outcomes confirm results obtained in recent randomized PCI trials and are modifiable, suggesting that further improvements can be made. (C) 2007 Published by Elsevier Ireland Ltd.
引用
收藏
页码:379 / 387
页数:9
相关论文
共 31 条
[1]   Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures - Systematic overview and meta-analysis of randomized trials [J].
Agostoni, P ;
Biondi-Zoccai, GGL ;
De Benedictis, ML ;
Rigattieri, S ;
Turri, M ;
Anselmi, M ;
Vassanelli, C ;
Zardini, P ;
Louvard, Y ;
Hamon, M .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2004, 44 (02) :349-356
[2]   A contemporary overview of percutaneous coronary interventions - The American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR) [J].
Anderson, HV ;
Shaw, RE ;
Brindis, RG ;
Hewitt, K ;
Krone, RJ ;
Block, PC ;
McKay, CR ;
Weintraub, WS .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2002, 39 (07) :1096-1103
[3]   Safety of concomitant therapy with eptifibatide and enoxaparin in patients undergoing percutaneous coronary intervention - Results of the coronary revascularization using integrilin and single bolus enoxaparin study [J].
Bhatt, DL ;
Lee, BI ;
Casterella, PJ ;
Pulsipher, M ;
Rogers, M ;
Cohen, M ;
Corrigan, VE ;
Ryan, TJ ;
Breall, JA ;
Moses, JW ;
Eaton, GM ;
Sklar, MA ;
Lincoff, AM .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2003, 41 (01) :20-25
[4]   Angiographic adverse events, creatine kinase-MB elevation, and ischemic end points complicating percutaneous coronary intervention (a REPLACE-2 substudy) [J].
Blankenship, JC ;
Haldis, T ;
Feit, F ;
Hu, TF ;
Kleiman, NS ;
Topol, EJ ;
Lincoff, AM .
AMERICAN JOURNAL OF CARDIOLOGY, 2006, 97 (11) :1591-1596
[5]  
Ferguson JJ, 2004, JAMA-J AM MED ASSOC, V292, P45
[6]   Intervention in acute coronary syndromes:: do patients undergo intervention on the basis of their risk characteristics?: The Global Registry of Acute Coronary Events (GRACE) [J].
Fox, K. A. A. ;
Anderson, F. A., Jr. ;
Dabbous, O. H. ;
Steg, P. G. ;
Lopez-Sendon, J. ;
Van de Werf, F. ;
Budaj, A. ;
Gurfinkel, E. P. ;
Goodman, S. G. ;
Brieger, D. .
HEART, 2007, 93 (02) :177-182
[7]   Medication performance measures and mortality following acute coronary syndromes [J].
Granger, CB ;
Steg, PG ;
Peterson, E ;
Lòpez-Sendón, J ;
Van de Werf, F ;
Kline-Rogers, E ;
Allegrone, J ;
Dabbous, OH ;
Klein, W ;
Fox, KAA ;
Eagle, KA .
AMERICAN JOURNAL OF MEDICINE, 2005, 118 (08) :858-865
[8]   Patients enrolled in coronary intervention trials are not representative of patients in clinical practice: results from the Euro Heart Survey on Coronary Revascularization [J].
Hordijk-Trion, M ;
Lenzen, M ;
Wijns, W ;
de Jaegere, P ;
Simoons, ML ;
Reimer, JMSO ;
Bertrand, ME ;
Mercado, N ;
Boersma, E .
EUROPEAN HEART JOURNAL, 2006, 27 (06) :671-678
[9]   A large-scale prospective cohort study on the current status of therapeutic modalities for acute myocardial infarction in Japan: Rationale and initial results of the HIJAMI Registry [J].
Kasanuki, H ;
Honda, T ;
Haze, K ;
Sumiyoshi, T ;
Horie, T ;
Yagi, M ;
Yamaguchi, J ;
Ishii, Y ;
Fujii, SY ;
Nagashima, M ;
Okada, H ;
Koganei, H ;
Koyanagi, R ;
Tsurumi, Y ;
Kimura, H ;
Ogawa, H .
AMERICAN HEART JOURNAL, 2005, 150 (03) :411-418
[10]   Bivalirudin and provisional glycoprotein IIb/IIIa blockade compared with heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary intervention - REPLACE-2 Randomized Trial [J].
Lincoff, AM ;
Bittl, JA ;
Harrington, RA ;
Feit, F ;
Kleiman, NS ;
Jackman, JD ;
Sarembock, IJ ;
Cohen, DJ ;
Spriggs, D ;
Ebrahimi, R ;
Keren, G ;
Carr, J ;
Cohen, EA ;
Betriu, A ;
Desmet, W ;
Kereiakes, DJ ;
Rutsch, W ;
Wilcox, RG ;
de Feyter, PJ ;
Vahanian, A ;
Topol, EJ .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2003, 289 (07) :853-863