Estudio de la carga trombótica angiográfica en angioplastina primaria

Résumé

Background: Thrombus burden is a useful parameter that can be assessed earlier than other angiographic parameters, and assist the interventional procedure. Previous studies have suggested a prognostic effect, related to an increased risk of stent thrombosis. However, data come from obsolete series and non-homogeneous populations. The aim of this study was to analyze the effect of thrombus burden in the incidence of major adverse cardiac events during mid-term follow-up. Methods: We conducted a prospective cohort study of 504 consecutive patients treated in a systematic primary percutaneous coronary intervention program. Angiograms were interpreted by investigators unaware of the clinical data. Large thrombus burden was defined as thrombus length ≥2 vessel diameters or as large thrombus obtained through catheter aspiration. The primary outcome measure was a composite of death, reinfarction, or target vessel revascularization. Results: Thrombus burden was evaluated in 435 patients, 205 (47%) of which met criteria for large thrombus burden. Direct stenting, abciximab infusion and catheter thrombus aspiration were performed more frequently in this group. Patients with larger thrombi showed worse reperfusion parameters (Blush 0/1, 20% vs. 12%, p=0,049) and larger infarcts (peak troponin I, 74 vs. 50 ng/mL, p=0.015). During a mean follow-up period of 19 ± 5 months, 37 (16.2%) patients in the small thrombus burden group, and 25 (12.8%) patients in the large thrombus group experienced the primary outcome. Large thrombus burden was not associated with the primary outcome in a Cox regression model (adjusted hazard ratio 0.88, 95% CI: 0.46 to 1.67, p=0.691). There were five angiographically confirmed stent thrombosis, four in the large thrombus burden group and one in the small thrombus burden group (2.2% vs. 0.5%, p=0.190). Conclusions: In a population with a low rate of stent thrombosis, large thrombus burden was not associated with a higher rate of clinical events during mid-term follow up. Thrombus quantification can help in efficient use of adjuvant therapies to optimize myocardial perfusion.