LB-10
Predictive value of the Thrombotic Risk Criteria of the 2020 ESC guidelines for NSTE-ACS: validation in a large PCI registry.
Presenter
George D. Dangas, M.D., Ph.D., MSCAI, Mount Sinai Hospital, New York, NY
George D. Dangas, M.D., Ph.D., MSCAI1, Alessandro Spirito, MD2, Samantha Sartori, PhD2, Davide Cao, MD2, Usman Baber, M.D.3, Ashutosh Sharma, M.D.4, Karim M Kamaleldin, MD2, Rebecca Cohen2, Kenneth Smith, MPH2, Birgit Vogel, MD2, David A. Power, MD5, Parasuram Melarcode-Krishnamoorthy, MD2, Annapoorna S. Kini, M.D.1, Samin K. Sharma, M.D., MSCAI2 and Roxana Mehran, M.D., MSCAI2, (1)Mount Sinai Hospital, New York, NY, (2)Icahn School of Medicine at Mount Sinai, New York, NY, (3)The University Of Oklahoma Health Sciences Center, Oklahoma City, OK, (4)The State University of New York at Buffalo, Buffalo, NY, (5)Icahn School of Medicine at Mount Sinai, New York City, NY
Keywords: Acute Coronary Syndromes (ACS), Coronary and Stable Ischemic Heart Disease (SIHD)
Background
Risk assessment before percutaneous coronary intervention (PCI) provides valuable information for patient’s management. We assessed the predictive value of the thrombotic risk criteria proposed in the 2020 ESC guidelines for non-ST-elevated acute coronary syndrome (NSTE-ACS)
Methods
Consecutive patients with acute or chronic coronary syndrome undergoing PCI at a large tertiary-care center from 2012 to 2019 were included. Patients were grouped into low, medium, and high thrombotic risk based on the ESC criteria (
Figure). The primary endpoint was major adverse cardiovascular events (MACE) at 1 year, a composite of all-cause death, myocardial infarction (MI) and stroke. Secondary endpoints included the individual components of the primary endpoint and major bleeding.
Results
Among 12,528 patients included, 1452 (12%) were at low-risk, 7016 (56%) at medium risk, and 4060 (32%) at high-risk. The 1-year risk of MACE was increased in patients at medium (HR 4.31, 95% CI 2.47-7.52) and high-risk (HR 6.16, 95% CI 3.52-10.8) as compared to those at low-risk, because of higher rates of all-cause death and MI in the two former groups. Major bleeding was significantly higher in high-risk patients (HR 1.39, 95% CI 1.06 - 1.84), but similar between the moderate and low-risk group (
Figure).
Conclusions
In patients undergoing PCI, the thrombotic risk criteria of the 2020 ESC guideline for NSTE-ACS enable the identification of patients at low, medium and high risk of MACE, all-cause death and MI at 1-year. Additionally, high-risk patients have a greater hazard of major bleeding.
