Harjai Kishore J, Grines Cindy, Stone Gregg W, Boura Judith, Turco Mark, Brodie Bruce, Sadeghi H Mehrdad, Cox David, Grines Lorelei, O' Neill William W
William Beaumont Hospital, Royal Oak, Michigan 48703, USA.
Am J Cardiol. 2003 Aug 15;92(4):377-82. doi: 10.1016/s0002-9149(03)00653-2.
The presence of intracoronary thrombus after percutaneous coronary intervention (PCI) worsens clinical outcomes. We performed this study to assess the incidence of intracoronary thrombus after primary angioplasty for acute myocardial infarction (AMI) and the clinical impact of nonocclusive thrombus. In 2,148 patients enrolled in the Primary Angioplasty in Myocardial Infarction (PAMI)-2, Stent PAMI, and PAMI No-Surgery-On-Site trials, we compared clinical and angiographic characteristics of 131 patients (6%) who had angiographically visible thrombus after PCI with those who did not (n = 2,017). In the subset of 2,115 patients with post-PCI Thrombolysis In Myocardial Infarction (TIMI) 2 or 3 flow, we assessed the impact of post-PCI thrombus (n = 110) on in-hospital, 1-month, and 1-year outcomes (reinfarction, ischemic target vessel revascularization [I-TVR], death, and major adverse cardiovascular events [MACEs] [i.e., death, reinfarction, or I-TVR]). Lack of stent use, presence of thrombus before PCI, and no history of PCI were independent correlates of post-PCI thrombus. Patients with nonocclusive thrombus after PCI had more reinfarctions during the index hospitalization (5.5% vs 2.0%, p = 0.03) and at 1 month (6.8% vs 2.3%, p = 0.01) and had nonsignificantly higher I-TVR (during hospitalization 5.5% vs 2.8%, p = 0.13; at 1 month 5.9% vs 3.4%, p = 0.17), but similar mortality and MACE rates as those without post-PCI thrombus. In multivariate analysis, post-PCI thrombus was not a significant predictor of in-hospital or 1-month reinfarction. At 1 year, clinical outcomes were similar between patient groups (reinfarction 8.3% vs 4.7%, p = 0.14; I-TVR 12.5% vs 12.1%, p = 0.91; death 5.9% vs 5.0%, p = 0.68; and MACEs 21% vs 18%, p = 0.54). We conclude that residual intracoronary thrombus after primary angioplasty is relatively uncommon. In patients who achieve TIMI 2 or 3 flow after PCI, intracoronary thrombus is associated with worse cardiovascular outcomes. However, differences in outcomes between patients with and without residual thombus are related to baseline clinical differences rather than thrombus per se.
经皮冠状动脉介入治疗（PCI）后冠状动脉内血栓的存在会使临床结局恶化。我们开展这项研究以评估急性心肌梗死（AMI）直接血管成形术后冠状动脉内血栓的发生率以及非闭塞性血栓的临床影响。在纳入心肌梗死直接血管成形术（PAMI）-2、支架PAMI和现场无手术PAMI试验的2148例患者中，我们比较了131例（6%）PCI术后血管造影可见血栓患者与无血栓患者（n = 2017）的临床和血管造影特征。在2115例PCI术后心肌梗死溶栓（TIMI）血流为2级或3级的患者亚组中，我们评估了PCI术后血栓（n = 110）对住院期间、1个月和1年结局（再梗死、缺血性靶血管血运重建[I-TVR]、死亡和主要不良心血管事件[MACE，即死亡、再梗死或I-TVR]）的影响。未使用支架、PCI术前存在血栓以及无PCI病史是PCI术后血栓的独立相关因素。PCI术后有非闭塞性血栓的患者在首次住院期间（5.5%对2.0%，p = 0.03）和1个月时（6.8%对2.3%，p = 0.01）再梗死更多，I-TVR略高（住院期间5.5%对2.8%，p = 0.13；1个月时5.9%对3.4%，p = 0.17），但死亡率和MACE发生率与无PCI术后血栓的患者相似。多变量分析显示，PCI术后血栓并非住院期间或1个月时再梗死的显著预测因素。1年时，患者组间临床结局相似（再梗死8.3%对4.7%，p = 0.14；I-TVR 12.5%对12.1%，p = 0.91；死亡5.9%对5.0%，p = 0.68；MACE 21%对18%，p = 0.54）。我们得出结论，直接血管成形术后冠状动脉内残留血栓相对少见。在PCI术后达到TIMI血流2级或3级的患者中，冠状动脉内血栓与更差的心血管结局相关。然而，有或无残留血栓患者之间结局的差异与基线临床差异有关，而非血栓本身。
