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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/11961

Title: Intraluminal Thrombus in Facilitated Versus Primary Percutaneous Coronary Intervention An Angiographic Substudy of the ASSENT-4 PCI (Assessment of the Safety and Efficacy of a New Treatment Strategy With Percutaneous Coronary Intervention) Trial
Authors: Zalewski, Jaroslaw
Desmet, Walter
Sinnaeve, Peter
Berger, Peter
Grines, Cindy
Danays, Thierry
Armstrong, Paul W.
Van de Werf, Frans
Issue Date: 2011
Abstract: Objectives This study investigated the occurrence of intraluminal thrombus and its potential implications with facilitated percutaneous coronary interventions (fPCIs). Background The effect of fPCI on the presence and consequences of intraluminal thrombus is unknown. Methods Thrombolysis In Myocardial Infarction (TIMI) flow grade, frame count, and thrombus grade; distal embolization; and slow flow in the infarct-related artery were assessed in a blinded fashion on coronary angiograms in 1,342 patients from the ASSENT-4 PCI (Assessment of the Safety and Efficacy of a New Treatment Strategy With Percutaneous Coronary Intervention) trial. Residual TIMI thrombus grade >= 2 and/or distal embolization and/or slow flow, reflecting thrombus burden (TB), following PCI were correlated with ST-segment resolution, epicardial blood flow, and clinical outcome. The clinical composite endpoint was death, congestive heart failure, or shock. Results In the fPCI group, more TIMI flow grade 2/3 in the infarct-related artery at the first angiogram (73.7% vs. 33.4%, p < 0.001) and a higher TB following PCI (19.7% vs. 13.4%, p = 0.002) were found in comparison with the primary PCI group. Post-PCI TIMI thrombus grade was significantly associated with ST-segment resolution (p < 0.001) and TIMI frame count (p < 0.0001) in both groups. In the fPCI group, the presence of post-PCI thrombus was associated with a significantly worse outcome at 90 days (clinical composite endpoint: 32.1% vs. 18.6%, p = 0.023). Multivariable logistic regression showed that facilitation with tenecteplase (p = 0.005) and TB (odds ratio: 2.43, 95% confidence interval: 1.30 to 4.51, p = 0.0052) were independent predictors of 90-day mortality. Conclusions In ASSENT-4 PCI, despite more patency, residual TB was significantly higher in fPCI patients and was associated with less efficient tissue reperfusion and worse clinical outcomes. (A Trial Evaluating the Efficacy and Safety of Tenecteplase Together With Unfractionated Heparin Prior to Early Percutaneous Coronary Intervention [PCI] as Compared to Standard Primary PCI in Patients With Acute Myocardial Infarction [ASSENT-4 PCI]; NCT00168792) (J Am Coll Cardiol 2011;57:1867-73) (C) 2011 by the American College of Cardiology Foundation
Notes: [Zalewski, Jaroslaw; Desmet, Walter; Sinnaeve, Peter; Van de Werf, Frans] Katholieke Univ Leuven, Dept Cardiovasc Med, B-3000 Louvain, Belgium. [Bogaerts, Kris] Univ Hasselt, Hasselt, Belgium. [Berger, Peter] Weis Ctr Res, Geisinger Clin, Danville, PA 17822 USA. [Grines, Cindy] William Beaumont Hosp, Royal Oak, MI 48072 USA. [Danays, Thierry] Boehringer Ingelheim GmbH & Co KG, Reims, France. [Armstrong, Paul] Univ Alberta, Dept Med, Div Cardiol, Edmonton, AB, Canada. frans.vandewerf@med.kuleuven.be
URI: http://hdl.handle.net/1942/11961
DOI: 10.1016/j.jacc.2010.10.061
ISI #: 000290210100004
ISSN: 0735-1097
Category: A1
Type: Journal Contribution
Validation: ecoom, 2012
Appears in Collections: Research publications

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