Effect of coronary thrombus on outcome of PCI in ACS

Effect of coronary thrombus on outcome of PCI in ACS

Intra coronary thrombus is a common observation on angiography in acute coronary syndromes. Kenji Goto, Alexandra J Lansky, Eugenia Nikolsky, Martin Fahy, Frederick Feit, E Magnus Ohman, Harvey D White, Roxana Mehran, Michel E Bertrand, Walter Desmet, Martial Hamon and Gregg W Stone evaluated the incidence and prognostic significance of pre procedural thrombus in patients undergoing percutaneous coronary intervention (PCI) by early invasive strategy in high risk acute coronary syndrome (ACS) [1]. Over three thousand and six hundred patients with moderate- and high-risk ACS undergoing PCI in the the ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) trial had their pre and post PCI angiograms evaluated in an independent core angiographic laboratory. The fifteen percent of patients who had thrombus had higher rates of final impaired epicardial coronary flow compared to the eighty five percent who did not have a thrombus. Presence of thrombus was found to be an independent predictor of thirty day mortality and myocardial infarction. It was also a pointer towards higher rate of stent thrombosis at thirty days. The final conclusion was that baseline coronary thrombus increased the rate of ischemic complications at thirty days and caused a three fold increase of death and myocardial infarction in the first year after intervention.

Reference

1. Kenji Goto, Alexandra J Lansky, Eugenia Nikolsky, Martin Fahy, Frederick Feit, E Magnus Ohman, Harvey D White, Roxana Mehran, Michel E Bertrand, Walter Desmet, Martial Hamon, Gregg W Stone. Prognostic Significance of Coronary Thrombus in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndromes: A Subanalysis of the ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) Trial. JACC Cardiovasc Interv. 2011 Jul;4(7):769-77.