[Influence of angiographically diagnosed thrombus-containing lesion on hospitalization and long-term prognosis of patients with acute coronary syndromes without persistent ST-segment elevation treated with early invasive strategy].
BACKGROUND
Thrombus containing lesions (TCL) are often associated with unfavourable immediate results of invasive procedures thus influencing long-term outcome. Early invasive treatment strategy employed in patients (pts) with acute coronary syndromes without sustained ST segment elevation (ACS) may be crucial for improvement of immediate and in-hospital results.


OBJECTIVE
The aim of this study was to find out whether the presence of thrombi in lesions related to instability may negatively affect the results of early invasive treatment strategy and long-term outcome of patients with acute coronary syndromes.


METHODS
We analyzed coronary angiograms of 364 consecutive pts with ACS who were assigned to early invasive treatment strategy. Pts with angiographically recognizable thrombus containing lesions (group A) were compared with remaining ones (group B) with regard to immediate results of percutaneous intervention (PCI), in-hospital outcome and 12-month follow up.


RESULTS
The study group consisted of 84 patients with TCL and 280 without thrombus. Pts with TCL were younger (58 +/- 9,9 vs 61 +/- 10,8; p<0,03) and less frequently had impaired LV function (EF<35%; 5% vs 13% p<0,04). Cardiac enzymes at admission were positive in 49% and 35% of pts in group A and B respectively (p<0,04). Baseline TIMI flow was 2,7 +/- 0,8 in group A and 2,5 +/- 0,9 in group B (NS) and TIMI 3 flow before PCI was observed in 54,8% and 69,3% of pts respectively (p<0,01). Type B and C lesions were observed in 100% and 91% culprit lesions respectively (p<0.05). TIMI flow after PCI was 2,9 +/- 0,4 in group A and 2,9+/-0,5 in group B and TIMI 3 flow after PCI was observed in 95,2% and 95,9% respectively (NS). GP IIB/IIIA antagonists were used in 4,8% pts of group A and 6,4% patients of group B. Frequency of stent implantation was 96,5% and 96,7% respectively (NS). One (1,2%) in-hospital death occurred in group A and 4 (1,4%) in group B (NS). Myocardial infarction was observed in 4 (4,8%) pts in group A and 12 (4,3%) in group B (NS). In 12-month follow up 2 (2,4%) deaths in group A and 10 (3,6%) in group B were observed (NS). No difference between groups was noted in myocardial infarction rate: 7,14% (group A) vs 2.84% (group B), NS. More pts in group B had episodes of unstable angina during follow up (19,5% vs 9,5%; p<0,04).


CONCLUSIONS
Thrombus containing lesions in patients with ACS assigned to early invasive strategy do not negatively influence the immediate, in-hospital and 1-year results of percutaneous intervention.
Szyguła-Jurkiewicz
Bozena
B
III Katedra i Oddział Kliniczny Kardiologii Sl. AM. b.szygula@sccs.pl
Wilczek
Krzysztof
K
Szyguła
Jacek
J
Poloński
Lech
L
D000208:Acute Disease; D000368:Aged; D000789:Angina, Unstable / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D011379:Prognosis; D013997:Time Factors