Background: There is disagreement concerning the prognostic value of a prior history of percutaneous coronary intervention (PCI) in patients with non-ST-segment elevation acute coronary syndromes (ACS). This study characterizes these patients and investigates the impact of prior PCI on their prognosis.
Methods: 448 consecutive patients admitted due to ACS between 1998 and 2000 were evaluated. Patients with prior PCI were compared to the others with regard to baseline demographic and clinical features. The study endpoint was death or myocardial infarction at one-year follow-up. The impact of prior PCI on the outcome was analyzed. In patients with prior PCI, the prognostic value of the time interval between PCI and current admission was assessed. In those patients who underwent coronary angiography during the index hospitalization, the culprit lesion features were evaluated.
Results: 134 patients (30%) with prior PCI were identified. Overall ACS patients had an event rate of 19% at one year. A history of prior PCI was not an independent predictor of outcome, but in the 44 patients with PCI performed during the 117 days before the index hospitalization, the event rate was significantly higher (30% versus 13%). Prior PCI in the previous 117 days was an independent risk predictor (adjusted OR 4.81; 95% CI, 1.57-14.71; p = 0.006). In these patients restenosis was the most frequent culprit lesion (60% versus 30%; p = 0.003).
Conclusions: In ACS patients, a history of PCI in the previous four months is an independent predictor of adverse outcome at one-year follow-up.