Does the presence of thrombus seen on a coronary angiogram affect the outcome after percutaneous coronary angioplasty? An Angiographic Trials Pool data experience

OBJECTIVES This study aimed to determine whether pre-existing angiographic thrombus was associated with adverse in-hospital and six-month outcomes aft er percutaneous coronary interventions. BACKGROUND There are conflicting data about whether pre-existing thrombus i s an independent predictor of adverse in-hospital and short-term outcome af ter coronary interventions. METHODS The Angiographic Trials Pool, a data set derived from eight prospec tive randomized trials, was analyzed. The study population consisted of 7,9 17 patients who underwent coronary interventions between 1986 and 1995. Two trials were excluded because they did not collect information regarding th rombus. Patients from the other six trials were divided on the basis of the presence or absence of thrombus. RESULTS In patients with (n = 2,752) and without (5,165) thrombus, in-hospi tal mortality following angioplasty was low (0.8 vs. 0.6%, p = 0.207). Seve ral adverse outcomes were higher in patients with thrombus: death/myocardia l infarction (8.4 vs. 5.5%, p less than or equal to 0.001), in-hospital abr upt closure (5.9 vs. 3.9%, p less than or equal to 0.001) and an in-hospita l composite of death, myocardial infarction and/or repeat revascularization (15.4 vs. 11.2%, p :5 0.001). Six-month mortality was low and comparable b etween the two groups (2.1 vs. 1.8%, p = 0.34), but the incidence of six-mo nth death/myocardial infarction was higher in patients with thrombus (11.7 vs. 8.7%, p less than or equal to 0.0001). CONCLUSIONS Percutaneous coronary angioplasty can be performed with low mor tality in patients with pre-existing thrombus, although these patients are at higher risk of in-hospital and six-month death/myocardial infarction. Co ntinued efforts are required to optimize the outcome in these high risk pat ients. (C) 2001 by the American College of Cardiology.