Early clinical and angiographic outcome of coronary stenting in thrombus-containing lesions

ABSTRACT

Percutaneous coronary intervention [PCI] and coronary stenting of thrombus-containing lesions have frequently been associated with an increased risk of adverse outcome. However, the strength of this association has varied and with the new antiplatelet agents and stents, it is not clear whether thrombus is still a risk factor after PCi. The study evaluated the early [in-hospital] clinical and angiographic outcomes of patients undergoing coronary stenting in lesions with angiographic evidence of intracoronary thrombus, A retrospective study comparing two groups of patients Group I included 64 patients who undetwent stent implantation in a single thrombus containing lesion, Group II included 293 patients who underwent stent implantation in a single non-thrombus containing lesion during the same time period [between June 1997 and April 2001]. Both groups were matched as regards the baseline clinical characteristics except that significantly more patients of group I were presented by unstable angina compared with group II 65.08% versus 47.78% [P<0.01]. Patients with thrombus [Group I] have significantly more RCA as the target vessel; 46.03% vs 30.03% [P<0.01] and significantly more complex lesion morphology; 42.86% vs 26.28% [P<005] compared with patients without thrombus [Group II]. The target vessel size and the baseline percent diameter stenosis were significantly higher In group I than group II [P<0.001 and P<0.01 respectively]. Similarly the largest balloon diameter and the mean number of inflations were significantly higher in group 1 than group II [P<0.001 and P<0.001 respectively]. Significantly more patients in group I received the GPIIb/I1Ia antagonist, tirofiban [Aggrastat] than group Ii; 20.63% vs 4.10% [P<0.001] although its use was rather limited in both groups. The angiographic success was almost identical for both groups 95.24% in group I vs 96.25% in group II. There were no statistically significant differences between both groups regarding all parameters of in-hospital outcomes, However, there was a trend towards more adverse events in group I compared to group II that did not reach statistical significance [Death 1.59% vs 0.34%, Q-Mi 3.17% vs 1.71%, Acute closure 4.76% vs 2.05%, Repeat PCI 4.76% vs 2.38%, Emergency CABG 0% vs 0%, and Procedural success 88.8% vs 94.28%]. Coronary stenting can be safely performed in patients with thrombus-containing lesions with excellent angiographic outcome and acceptable, though less favorable in-hospital clinical outcome: