918-19 The Effect of Preprocedural Intracoronary Thrombus on Patient Outcome After Percutaneous Coronary Intervention

The outcome of percutaneous coronary interventions in patients with preprocedural angiographic evidence of thrombus at the target lesion is uncertain. Detailed angiographic and clinical data were prospectively collected from 2,164 patients enrolled in 3 clinical trials with stable and unstable angina undergoing non-emergency percutaneous coronary interventions. Procedural success (l50% final visual stenosis without death or emergency CABG) and the presence of preprocedural intracoronary thrombus, defined as a discrete filling defect at the target lesion, were determined by core laboratory review. Patient age, prior cardiac history, cardiovascular risk factors, and severity of disease were well matched between patients with and without thrombus. Outcomes with 95% confidence intervals were: Outcomes Stable Angina Unstable Angina (n = 450) No Thrombus (n = 1,476) Thrombus (n = 238) Procedural Success 87% (84–90%) 85% (183–87%) 80% (175–85%) Abrupt Closure 4% (2–6%) 6% (5–7%) 11% (17–15%) In–Hospital Death l1% 1% 0 MI 5% 3% 5% CABG 2% 4% 9% Repeat PTCA 3% 3% 2% Composite Outcome 6% (14–8%) 8% (17–9%) 12% (18–16%) Six–Month Outcome 27% (23–31%) 29% (27–31%) 34% (128–40%) Patients with unstable angina and intracoronary thrombus are more likely to have lower procedural success, higher abrupt closure risk, and worse inhospital clinical outcome. Patients with unstable angina and preprocedural intracoronary thrombus represent a high risk group for which new strategies need to be developed to improve the outcome of percutaneous interventions.