Abstract 11324: Immediate Percutaneous Coronary Intervention in Patients with Refractory Out of Hospital Cardiac Arrest

Background: An increasing number of cardiac centres are using immediate percutaneous coronary intervention (PCI) and extracorporeal cardiopulmonary resuscitation (ECPR) in patients with refractory out of hospital cardiac arrest (r-OHCA). Published evidence regarding PCI in OHCA has been mainly reporting to patients with early return of spontaneous circulation and the influence of PCI and ECPR on survival in the population of patients with r-OHCA and acute coronary syndrome (ACS) remains unclear. Methods: In this post hoc analysis of the randomized r-OHCA trial, all patients with ACS as a cause of r-OHCA were included. The effect of successful PCI and ECPR on 180-days survival was examined using Kaplan-Meier estimates and multivariable Cox regression. Results: In total, 256 patients were evaluated in Prague OHCA study and 127 (49.6 %) had ACS as the cause of r-OHCA constituting current study population. The mean age was 58 years (46.3-64) and duration of resuscitation was 52.5 minutes (36.5-68). ECPR was used in 51 (40.2 %) of patients. Immediate PCI was performed in 86 (67.7%) patients and TIMI flow 2 or 3 was achieved in 75 (87.2%) patients. The overall 180-days survival of patients with successful PCI was 40 % compared to 7.7 % with no or failed immediate PCI (log-rank p < 0.001). After adjustment for confounders, successful PCI was associated with a lower risk of death (HR 0.47, CI 0.24-0.93, p = 0.031). Likewise, ECPR was associated with a lower risk of death (HR 0.11, CI 0.05-0.24, p< 0.001). Conclusion: In this post hoc analysis of the randomized r-OHCA trial, successful immediate PCI as well as ECPR were associated with improved 180-days survival in patients with r-OHCA due to ACS.

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Guided de-escalation of DAPT in acute coronary syndrome patients undergoing percutaneous coronary intervention with BVS implantation: a post-hoc analysis from the randomized TROPICAL-ACS trial

Journal of Thrombosis and Thrombolysis ◽

10.1007/s11239-019-01811-2 ◽

2019 ◽

Vol 47 (3) ◽

pp. 427-435 ◽

Cited By ~ 2

Author(s):

Lukasz Koltowski ◽

Mariusz Tomaniak ◽

Lisa Gross ◽

Bartosz Rymuza ◽

Michal Kowara ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Acute Coronary Syndrome ◽

Coronary Intervention ◽

Post Hoc Analysis ◽

Coronary Syndrome ◽

Percutaneous Coronary ◽

Post Hoc

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TCT-777 Guided De-Escalation of DAPT in Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention with BVS implantation: A post-hoc Analysis from the Randomized TROPICAL-ACS Trial

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2018.08.2007 ◽

2018 ◽

Vol 72 (13) ◽

pp. B310

Author(s):

Lukasz Koltowski ◽

Mariusz Tomaniak ◽

Bartosz Rymuza ◽

Michal Kowara ◽

Radoslaw Parma ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Acute Coronary Syndrome ◽

Coronary Intervention ◽

Post Hoc Analysis ◽

Coronary Syndrome ◽

Percutaneous Coronary ◽

Post Hoc

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Abstract 15664: Prior Oral Anticoagulant Status and Outcomes in Patients With Atrial Fibrillation With an Acute Coronary Syndrome and/or Undergoing Percutaneous Coronary Intervention: Insights From the Augustus Trial

Circulation ◽

10.1161/circ.142.suppl_3.15664 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Robert C Welsh ◽

Renato D Lopes ◽

Daniel Wojdyla ◽

Ronald Aronson ◽

Christopher B Granger ◽

...

Keyword(s):

Atrial Fibrillation ◽

Percutaneous Coronary Intervention ◽

Acute Coronary Syndrome ◽

Oral Anticoagulant ◽

Lower Risk ◽

Coronary Intervention ◽

Risk Of Death ◽

Coronary Syndrome ◽

Percutaneous Coronary ◽

Ischemic Events

Background: Managing antithrombotic therapy transitions at hospital admission and discharge in patients with atrial fibrillation (AF) and an acute coronary syndrome (ACS) or percutaneous coronary intervention (PCI) is challenging and is affected by prior treatment. We examined oral anticoagulant (OAC) use prior to enrollment and the relationship with outcomes in the AUGUSTUS trial. Methods: Patients in AUGUSTUS (N=4,614) were analyzed according to whether they were [n=2262] or were not [n=2352] on a prior OAC. Bleeding and clinical outcomes were compared by Kaplan-Meier (KM) estimates at 180 days. For each outcome, KM estimates and treatment interactions were determined by randomized arm and prior OAC status. Results: Those with prior OAC use had higher CHA 2 DS 2 -VASC and HAS-BLED scores and more comorbid medical conditions (hypertension, heart failure, diabetes, prior stroke), and were more likely to have been enrolled following elective PCI. Prior OAC use included vitamin K antagonists (VKAs) 47%, rivaroxaban 22%, apixaban 22%, dabigatran 12%, and edoxaban 1%. There was no difference in combined ISTH major/clinically relevant non-major (CRNM) bleeding with or without prior OAC use (13.5% vs. 13.5%; HR 1.00, 95% CI 0.85-1.18). Patients with prior OAC use had lower risk of death or ischemic events (5.4% vs. 7.6%; HR 0.72, 95% CI 0.57-0.91). No interactions were observed between randomized treatment (apixaban vs. VKA and aspirin vs. placebo) and prior OAC status for outcomes other than MI where apixaban (vs. VKA) was associated with a lower risk of MI in those with prior OAC use (Figure). Conclusion: In AUGUSTUS, OAC prior to enrollment was more common in patients with comorbidities and those enrolled following elective PCI. Prior OAC was associated with fewer ischemic events but not more bleeding. Our results support the use of apixaban plus a P2Y12 inhibitor without aspirin for patients with AF and ACS/PCI, irrespective of prior OAC use.

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