Predictive Value of the Thrombotic Risk Criteria of the 2020 ESC Guidelines for NSTE-ACS: Validation in a Large PCI Registry | SCAI

Why is this study important? 

  • Thrombotic risk assessment of patients prior to undergoing percutaneous coronary intervention (PCI) provides valuable information and can guide patient’s management.

What question was this study supposed to answer?

  • The study evaluated the predictive value of the thrombotic risk criteria proposed in the 2020 European Society of Cardiology (ESC) guidelines for non-ST-elevated acute coronary syndrome (NSTE- ACS).
  • Consecutive patients with acute or chronic coronary syndrome undergoing PCI at a large tertiary-care center from 2012 to 2019 were grouped into low, medium, and high thrombotic risk based on the ESC criteria.
  • 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.

What did the study show?

  • 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.
  • 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 groups.
  • In summary, the thrombotic risk criteria of the 2020 ESC guidelines for NSTE-ACS allows the identification of patients at low, medium, and high risk for MACE, all-cause death, and MI at 1-year. Additionally, the study showed that major bleeding is more likely to occur in high-risk patients.