Amraotkar Alok R, Ghafghazi Shahab, Trainor Patrick J, Hargis Charles W, Irfan Affan B, Rai Shesh N, Bhatnagar Aruni, DeFilippis Andrew P
Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky, United States KentuckyOne Health, Jewish Hospital, Louisville, Kentucky, United States Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland, United States.
Cardiol J. 2017;24(1):25-34. doi: 10.5603/CJ.a2017.0004. Epub 2017 Feb 2.
Coronary angiography is frequently employed to aid in the diagnosis of acute coronary thrombosis, but there is limited data to support its efficacy. The aim of the study was to evaluate sensitivity and specificity of five commonly used angiographic characteristics for diagnosis of acute coronary thrombosis: Ambrose complex lesion morphology; spherical, ovoid, or irregular filling defect; abrupt vessel cutoff; intraluminal staining; and any coronary filling defect.
Coronary angiography of 80 acute myocardial infarction or stable coronary artery disease subjects were assessed in blinded fashion, for the presence or absence of five angiographic characteristics. Only lesions of ≥ 10% stenosis were included in the analysis. Presence or absence of each angiographic characteristic was compared between lesions with or without the following study defined outcomes: 1) histologically confirmed thrombus, 2) highly probable thrombus, and 3) highly unlikely thrombus.
A total of 323 lesions were evaluated. All studied angiographic characteristics were associated with histologically confirmed and highly probable thrombotic lesions vs. lesions not meeting criteria for these outcomes (p < 0.03), except for complex Ambrose morphology which was not associated with any of the study outcomes (p > 0.05). Specificity for identifying histologically confirmed or highly probable thrombotic lesion was high (92-100%), especially for spherical, ovoid, or irregular filling defect (99-100%) and intraluminal staining (99%). Sensitivity for identification of histologically confirmed or highly probable thrombotic lesions was low for all tested angiographic characteristics (17-60%).
The presence of spherical, ovoid, or irregular filling defect or intraluminal staining was highly suggestive of coronary thrombus. However, none of the evaluated angiographic characteristics were useful for ruling out the presence of coronary thrombus. If confirmed in an independent cohort, these angiographic characteristic will be of significant value in confirming the diagnosis of acute coronary thrombosis.
冠状动脉造影术常用于辅助诊断急性冠状动脉血栓形成，但支持其疗效的数据有限。本研究的目的是评估五种常用的血管造影特征对急性冠状动脉血栓形成诊断的敏感性和特异性：安布罗斯复杂病变形态；球形、椭圆形或不规则充盈缺损；血管突然中断；腔内染色；以及任何冠状动脉充盈缺损。
以盲法评估80例急性心肌梗死或稳定型冠状动脉疾病患者的冠状动脉造影，观察是否存在五种血管造影特征。分析仅纳入狭窄≥10%的病变。比较具有或不具有以下研究定义结果的病变之间每种血管造影特征的存在与否：1）组织学证实的血栓，2）高度可能的血栓，3）高度不可能的血栓。
共评估了323个病变。除安布罗斯复杂形态与任何研究结果均无关联外（p>0.05），所有研究的血管造影特征均与组织学证实的和高度可能的血栓性病变相关，而与不符合这些结果标准的病变不同（p<0.03）。识别组织学证实或高度可能的血栓性病变的特异性较高（92%-100%），尤其是球形、椭圆形或不规则充盈缺损（99%-100%）和腔内染色（99%）。所有测试的血管造影特征识别组织学证实或高度可能的血栓性病变的敏感性较低（17%-60%）。
球形、椭圆形或不规则充盈缺损或腔内染色的存在高度提示冠状动脉血栓形成。然而，所评估的血管造影特征均无助于排除冠状动脉血栓的存在。如果在独立队列中得到证实，这些血管造影特征将对确诊急性冠状动脉血栓形成具有重要价值。
