Does the presence of thrombus seen on a coronary angiogram affect the outcome after percutaneous coronary angioplasty? An angiographic trials pool data experience
Mandeep Singh, MDa,
Guy S. Reeder, MD, FACCa,
E. Magnus Ohman, MD, FACCb,
Verghese Mathew, MD, FACCa,
William B. Hillegass, MD, FACCb,
R. David Anderson, MD, FACCb,
Dianne S. Gallup, MSb,
Kirk N. Garratt, MD, FACCa and
David R. Holmes, Jr, MD, FACCa
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
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Figure 1 Kaplan-Meier curve depicting the probability of death/myocardial infarction (MI) in the six months following the initial procedure. The heavy line represents patients with thrombus.
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Figure 2 Odds ratios for in-hospital adverse outcomes in patients with thrombus. These models were adjusted for the trial in which patients were enrolled, their age, history of angina, history of diabetes, prior percutaneous transluminal coronary angioplasty and prior coronary artery bypass grafting. Among all patients with thrombus, the odds of myocardial infarction (MI) were 1.33 and of death/MI were 1.30 relative to the odds of patients without thrombus. These odds were somewhat reduced (1.28 and 1.26, respectively), although still significantly different from patients without thrombus, when only patients without vein grafts were considered.
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Figure 3 Hazard ratios for six-month adverse outcomes in patients with thrombus. The models for myocardial infarction (MI) were adjusted for the trial in which patients were enrolled, their age, first-degree relative with history of coronary artery disease, history of angina, prior angioplasty, bypass surgery and thrombus. The models for death/MI were adjusted for the trial in which patients were enrolled, their age, first-degree relative with a history of coronary artery disease, prior percutaneous transluminal coronary angioplasty and coronary artery bypass grafting, three-vessel disease and thrombus.
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Figure 4 Odds ratios for in-hospital adverse outcomes in patients with and without thrombus enrolled in glycoprotein IIb/IIIa inhibitor trials (Evaluation of 7E3 for the Prevention of Ischemic Complications [EPIC] and Integrilin to Minimize Platelet Aggregation and Coronary Thrombosis II [IMPACT-II]). These models were adjusted for the specific trials patients were enrolled in, age, history of angina, history of diabetes mellitus, prior coronary intervention, prior coronary artery bypass grafting, thrombus, treatment (IIb/IIIa inhibitors) and treatment-thrombus interaction. Patients without thrombus showed a clear benefit from treatment, unlike patients with thrombus. MI = myocardial infarction.
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Figure 5 Hazard ratios for six-month adverse outcomes in patients with thrombus enrolled in glycoprotein IIb/IIIa inhibitor trials (Evaluation of 7E3 for the Prevention of Ischemic Complications [EPIC] and Integrilin to Minimize Platelet Aggregation and Coronary Thrombosis II [IMPACT-II]). The model for six-month myocardial infarction (MI) was adjusted for the trial in which the patient was enrolled, age, first-degree relative with a history of coronary artery disease, history of angina, prior coronary intervention, prior surgical revascularization and treatment (glycoprotein IIb/IIIa inhibitors). The model for six-month death/MI was adjusted for the trial in which the patient was enrolled, age, first-degree relative with a history of coronary artery disease, three-vessel disease, prior coronary intervention and prior surgical revascularization, and treatment.
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