Safety and Efficacy of Intense Antithrombotic Treatment and Percutaneous Coronary Intervention Deferral in Patients With Large Intracoronary Thrombus

• Published in: The American journal of cardiology 2013-06, Vol.111 (12), p.1745-1750
• Main Authors: Echavarría-Pinto, Mauro, MD, Lopes, Ricardo, MD, Gorgadze, Tamara, MD, Gonzalo, Nieves, MD, PhD, Hernández, Rosana, MD, PhD, Jiménez-Quevedo, Pilar, MD, PhD, Alfonso, Fernando, MD, PhD, Bañuelos, Camino, MD, Nuñez-Gil, Ivan J., MD, PhD, Ibañez, Borja, MD, PhD, Fernández, Cristina, MD, PhD, Fernandez-Ortiz, Antonio, MD, PhD, García, Eulogio, MD, Macaya, Carlos, MD, PhD, Escaned, Javier, MD, PhD
• Format: Article
• Language: English
• Subjects: Acute Coronary Syndrome - complications; Acute Coronary Syndrome - diagnostic imaging; Acute Coronary Syndrome - drug therapy; Acute Coronary Syndrome - therapy; Angina pectoris; Angiography; Angioplasty, Balloon, Coronary; Anticoagulants - therapeutic use; Aspirin - therapeutic use; Cardiology; Cardiovascular; Cohort Studies; Coronary Thrombosis - complications; Coronary vessels; Enoxaparin - therapeutic use; Heart attacks; Humans; Inpatients; Platelet Aggregation Inhibitors - therapeutic use; Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors; Prospective Studies; Thrombectomy; Thrombolytic Therapy - adverse effects; Thrombolytic Therapy - methods; Ticlopidine - analogs & derivatives; Ticlopidine - therapeutic use; Veins & arteries
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2013.02.027

The optimal management of a large intracoronary thrombus in patients with acute coronary syndromes without an urgent need of revascularization is unclear. We investigated whether deferring percutaneous coronary intervention (PCI) after a course of intensive antithrombotic therapy (ATT) (glycoprotein IIb/IIIa inhibitors, enoxaparin, aspirin, and clopidogrel) improves the outcomes compared with immediate PCI. We studied 133 stable patients with ACS and a large intracoronary thrombus and without an urgent need for revascularization at angiography. The angiographic and in-hospital outcomes of a prospective cohort of 89 patients who had undergone deferred angiography with or without PCI after ATT (d-PCI) were compared with a historical cohort of 44 patients who had undergone immediate PCI, matched for age, gender, and Thrombolysis In Myocardial Infarction thrombus grade. The absolute thrombus volume was measured before and after ATT using dual quantitative coronary angiography. All d-PCI patients remained stable during ATT (60.0 ± 30.8 hours). A significant reduction in the Thrombolysis In Myocardial Infarction thrombus grade (4, range 4 to 5, vs 3, range 2 to 4; p