Abstract 4601: Prognostic Significance of Thrombus in Patients With Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndromes; ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) Subanalysis
Objective- To compare impact of thrombus on baseline angiogram on outcomes of moderate-to high-risk patients with acute coronary syndromes (ACS) undergoing early revascularization using percutaneous coronary intervention (PCI) in the Acute Catheterization and Urgent Intervention Triage strategY (ACUITY) Trial.
Background- Incidence and implications of thrombus on baseline angiogram in patients with unstable angina and non ST-segment elevation ACS have not been studied systematically.
Methods- In ACUITY, among a total of 7789 patients with moderate- to high risk ACS undergoing PCI, 3650 patients had baseline and final angiograms analyzed by the angiographic core laboratory including 533 (15%) and 3117 (85%) patients with and without thrombus, respectively.
Results- Presence of thrombus was associated with younger age, male gender, fewer co-morbidities, higher rates of cardiac markers elevation, and more frequent right coronary artery culprit vessel. Patients with vs. without thrombus had lower rates of final TIMI flow grade 3 (89.9% vs. 97.5%, p<0.0001) and higher incidence of procedural complications including abrupt vessel closure (3.2% vs. 0.3%, p<0.0001), no reflow (1.7% vs. 0.3%, p=0.0003), and dissection (9.2% vs. 3.1%, p<0.0001). At 30 days, patients with vs. without thrombus had no significant differences in rates of death (1.3% vs. 0.8%, p=0.20) or unplanned revascularization (4.3% vs. 3.6%, p=0.46) but had higher rates of myocardial infarction (MI) (10.3% vs. 7.0%, p=0.01) and composite ischemia (12.9% vs. 9.5%, p=0.02). At 1 year rates of MI continued to be higher in patients with thrombus (14.3% vs. 9.8%, p=0.002). By multivariable analysis, thrombus was an independent predictor of MI at 30 days and at 1 year (OR 1.80 [1.30, 2.50] and 1.94 [1.34, 2.79], respectively; p=0.0004 for both).
Conclusions- Thrombus on baseline angiogram may be identified in 15% of moderate- to high risk patients with ACS undergoing early revascularization with PCI. Presence of thrombus is associated with higher rates of procedural complications, less frequent normalization of epicardial flow and higher rates of reinfarction at 30 days and 1 year.