Abstract 14829: Prognostic Impact of Thrombus Burden as Evaluated by OCT in Patients With non-ST Elevation Acute Coronary Syndromes Undergoing PCI
Introduction: We aimed to evaluate the impact of thrombus burden quantified by optical coherence tomography (OCT) on the risk of peri-procedural myocardial infarction (MI) (type IVa) in patients undergoing percutaneous coronary intervention (PCI) for non-ST elevation acute coronary syndrome (NSTEACS).
Methods: Prospective study including consecutive patients treated for NSTEACS (≤72 hours) by PCI in a large university hospital. Thrombus burden was evaluated before PCI using the semi-quantitative OCT thrombus score, in addition to quantitative measurement of thrombus volume. Plaque morphology was evaluated (nature of the plaque (fibrous vs lipid-rich), presence of calcified nodules, presence of plaque neovascularisation, presence of necrotic core, and fibrous cap thickness).
Results: In total, 88 patients aged 61±11.7 years were included. Thrombus was observed on OCT in 71 (80.7%), and by angiography in 44 (50%). Peri-procedural MI occurred in 39 patients (44%). OCT thrombus score was 17.48±18.4 in patients with peri-procedural MI, vs 13.14±18.3 in those without (p=0.27), while thrombus volume was 4.40±4.30mm3 vs 2.06±2.67mm3, with vs without MI respectively (p=0.019). There was no significant relation between plaque morphology by OCT, and either thrombus score, thrombus volume, or occurrence of peri-procedural MI. By multivariate analysis, only quantitative thrombus volume was significantly associated with the occurrence of peri-procedural MI (p<0.01).
Conclusions: OCT thrombus score did not predict occurrence of peri-procedural MI in our series of patients with NSTEACS undergoing PCI. Conversely, thrombus volume was significantly associated with an increased risk of peri-procedural MI in these patients. These findings plead in favour of quantitative measurement of thrombus volume instead of semi-quantitative assessment, to predict the risk of peri-procedural MI in NSTEACS patients undergoing PCI.
Author Disclosures: N. Braik: None. M. Chatot: None. B. Bonnet: None. F. Ecarnot: None. R. Chopard: None. M. Badoz: None. M. Seronde: None. F. Schiele: None. N.F. Meneveau: Speakers Bureau; Modest; St Jude Medical, Bayer, Daiichi Sankyo, BMS.
- © 2016 by American Heart Association, Inc.