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CLINICAL STUDY: INTERVENTIONAL CARDIOLOGY

Does the presence of thrombus seen on a coronary angiogram affect the outcome after percutaneous coronary angioplasty? An angiographic trials pool data experience

^a Division of Internal Medicine and Cardiovascular Diseases, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA
^b Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA

Manuscript received December 1, 2000; revised manuscript received May 11, 2001, accepted May 23, 2001.

Reprint requests and correspondence: Dr. David R. Holmes, Jr., Division of Internal Medicine and Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905
holmes.david{at}mayo.edu

OBJECTIVES

This study aimed to determine whether pre-existing angiographic thrombus was associated with adverse in-hospital and six-month outcomes after percutaneous coronary interventions.

BACKGROUND

There are conflicting data about whether pre-existing thrombus is an independent predictor of adverse in-hospital and short-term outcome after coronary interventions.

METHODS

The Angiographic Trials Pool, a data set derived from eight prospective randomized trials, was analyzed. The study population consisted of 7,917 patients who underwent coronary interventions between 1986 and 1995. Two trials were excluded because they did not collect information regarding thrombus. Patients from the other six trials were divided on the basis of the presence or absence of thrombus.

RESULTS

In patients with (n = 2,752) and without (5,165) thrombus, in-hospital mortality following angioplasty was low (0.8 vs. 0.6%, p = 0.207). Several adverse outcomes were higher in patients with thrombus: death/myocardial infarction (8.4 vs. 5.5%, p 0.001), in-hospital abrupt closure (5.9 vs. 3.9%, p 0.001) and an in-hospital composite of death, myocardial infarction and/or repeat revascularization (15.4 vs. 11.2%, p 0.001). Six-month mortality was low and comparable between the two groups (2.1 vs. 1.8%, p = 0.34), but the incidence of six-month death/myocardial infarction was higher in patients with thrombus (11.7 vs. 8.7%, p 0.0001).

CONCLUSIONS

Percutaneous coronary angioplasty can be performed with low mortality in patients with pre-existing thrombus, although these patients are at higher risk of in-hospital and six-month death/myocardial infarction. Continued efforts are required to optimize the outcome in these high risk patients.

Abbreviations and Acronyms   CABG = coronary artery bypass grafting   CADRES = Predicting the risk of Abrupt Vessel Closure in an Individual Patient   CAVEAT = Coronary Angioplasty Versus Excisional Atherectomy Trial   CAVEAT-II = Coronary Angioplasty Versus Excisional Atherectomy Trial-II   EPIC = Evaluation of 7E3 for the Prevention of Ischemic Complications   EPISTENT = Evaluation of Platelet IIb/IIIa Inhibitor for Stenting   IMPACT-II = Integrilin to Minimize Platelet Aggregation and Coronary Thrombosis-II   MI = myocardial infarction   PBC = Perfusion Balloon Catheter study   PRISM-PLUS = Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms

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