TY - JOUR
T1 - Prognostic significance of coronary thrombus in patients undergoing percutaneous coronary intervention for acute coronary syndromes
T2 - A subanalysis of the acuity (acute catheterization and urgent intervention triage strategY) trial
AU - Goto, Kenji
AU - Lansky, Alexandra J.
AU - Nikolsky, Eugenia
AU - Fahy, Martin
AU - Feit, Frederick
AU - Ohman, E. Magnus
AU - White, Harvey D.
AU - Mehran, Roxana
AU - Bertrand, Michel E.
AU - Desmet, Walter
AU - Hamon, Martial
AU - Stone, Gregg W.
N1 - Funding Information:
The ACUITY trial was sponsored and funded by The Medicines Company and Nycomed. Dr. Lansky has received research grants from The Medicines Company , Cordis , Boston Scientific , Medtronic , and Abbott , and serves on the Speakers' Bureau of Amgen, Pfizer, and Schering-Plough. Dr. Nikolsky is a consultant to Medtronic. Dr. Feit is a shareholder for Johnson & Johnson, Eli Lilly, and The Medicines Company. Dr. Ohman has received consulting fees from The Medicines Company, Liposcience, Inovise Medical, Response Biomedical, Datascope, Abiomed, AstraZeneca, Boehringer-Ingelheim, Bristol-Myers Squibb, Gilead Sciences, Merck, Pozen Inc., Roche, Sanofi-Aventis, and WebMD; he has equity interests in Medtronic and Savacor; has received research grants from Daiichi Sankyo , Eli Lilly & Co. , and Maquet ; has received lecture fees from Schering-Plough, Bristol-Myers Squibb, and Datascope; received grant support from The Medicines Company , Schering-Plough , Bristol-Myers Squibb , sanofi-aventis , Millennium Pharmaceuticals , Eli Lilly & Co. , and Daiichi Sankyo ; and is on the Speakers' Bureau for CV Therapeutics and The Medicines Company. Dr. White has received grant support from The Medicines Company , sanofi-aventis , Schering-Plough , Eli Lilly & Co. , Merck Sharp & Dohme , National Institutes of Health , Pfizer , Roche , Johnson & Johnson , AstraZeneca , GlaxoSmithKline , Daiichi Sankyo , Pharma Development , and Bristol-Myers Squibb , and is a consultant to Regado Biosciences. Dr. Mehran is a consultant to and on the advisory board for Abbott Vascular, AstraZeneca, OrthoMcNeil, Regado Biosciences, and received research grants (institutional) from Bristol-Myers Squibb / sanofi-aventis . Dr. Hamon has received research grants from Eli Lilly & Co. , GlaxoSmithKline , and The Medicines Company . Dr. Stone reports being on the advisory board for and receiving honoraria from Boston Scientific and Abbott Vascular, and is a consultant to Medtronic, Merck, The Medicines Company, Eli Lilly & Co., AstraZeneca, and Bristol-Myers Squibb-Sanofi. All other authors have reported that they have no relationships to disclose.
PY - 2011/7
Y1 - 2011/7
N2 - Objectives: The objective of this study is to investigate the incidence and clinical implications of thrombus on baseline angiography among patients presenting with nonST-segment elevation acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI). Background: Given current advances in the pharmacological and mechanical treatment of ACS patients managed with an early invasive strategy, the incidence and prognostic importance of pre-procedural lesion thrombus is warranted. Methods: In the ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) trial, a total of 3,627 patients with moderate- and high-risk ACS undergoing PCI had their baseline and final post-PCI angiograms analyzed by an independent angiographic core laboratory. Results: Patients with thrombus (n = 530 [15%]) compared with those without thrombus had higher rates of impaired final epicardial coronary flow (final Thrombolysis In Myocardial Infarction [TIMI] flow grade 3: 89.6% vs. 97.1%, p < 0.0001). Thrombus was an independent predictor of 30 day death (odds ratio [OR]: 3.16 [95% confidence interval (CI): 1.20 to 8.37], p = 0.02), and myocardial infarction (MI) at 30 days (OR: 1.62 [95% CI: 1.17 to 2.24], p = 0.003) and at 1 year (OR: 1.56 [95% CI: 1.16 to 2.08], p = 0.003). Patients with thrombus had significantly higher rates of stent thrombosis (ST) compared with patients without thrombus at 30 days (2.8% vs. 1.1%, p = 0.002) and at 1 year (3.7% vs. 1.8%, p = 0.003), and thrombus was an independent predictor of ST at both 30 days (OR: 2.61 [95% CI: 1.38 to 4.91]) and 1 year (OR: 2.98 [95% CI: 1.64 to 5.42]). Conclusions: Pre-procedural thrombus was present in 15% of moderate- and high-risk ACS patients undergoing PCI in the ACUITY trial. Baseline thrombus predicts increased ischemic complications at 30 days including a 3-fold increased risk of death as well as MI up to 1 year. Further evaluation of adjunctive pharmacotherapy is needed in this high-risk population.
AB - Objectives: The objective of this study is to investigate the incidence and clinical implications of thrombus on baseline angiography among patients presenting with nonST-segment elevation acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI). Background: Given current advances in the pharmacological and mechanical treatment of ACS patients managed with an early invasive strategy, the incidence and prognostic importance of pre-procedural lesion thrombus is warranted. Methods: In the ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) trial, a total of 3,627 patients with moderate- and high-risk ACS undergoing PCI had their baseline and final post-PCI angiograms analyzed by an independent angiographic core laboratory. Results: Patients with thrombus (n = 530 [15%]) compared with those without thrombus had higher rates of impaired final epicardial coronary flow (final Thrombolysis In Myocardial Infarction [TIMI] flow grade 3: 89.6% vs. 97.1%, p < 0.0001). Thrombus was an independent predictor of 30 day death (odds ratio [OR]: 3.16 [95% confidence interval (CI): 1.20 to 8.37], p = 0.02), and myocardial infarction (MI) at 30 days (OR: 1.62 [95% CI: 1.17 to 2.24], p = 0.003) and at 1 year (OR: 1.56 [95% CI: 1.16 to 2.08], p = 0.003). Patients with thrombus had significantly higher rates of stent thrombosis (ST) compared with patients without thrombus at 30 days (2.8% vs. 1.1%, p = 0.002) and at 1 year (3.7% vs. 1.8%, p = 0.003), and thrombus was an independent predictor of ST at both 30 days (OR: 2.61 [95% CI: 1.38 to 4.91]) and 1 year (OR: 2.98 [95% CI: 1.64 to 5.42]). Conclusions: Pre-procedural thrombus was present in 15% of moderate- and high-risk ACS patients undergoing PCI in the ACUITY trial. Baseline thrombus predicts increased ischemic complications at 30 days including a 3-fold increased risk of death as well as MI up to 1 year. Further evaluation of adjunctive pharmacotherapy is needed in this high-risk population.
KW - acute coronary syndrome(s)
KW - antithrombin
KW - percutaneous coronary intervention
KW - prognosis
KW - thrombus
UR - http://www.scopus.com/inward/record.url?scp=79960603978&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2011.02.019
DO - 10.1016/j.jcin.2011.02.019
M3 - Article
C2 - 21777885
AN - SCOPUS:79960603978
SN - 1936-8798
VL - 4
SP - 769
EP - 777
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 7
ER -