Intraprocedural Thrombotic Events During Percutaneous Coronary Intervention in Patients With Non–ST-Segment Elevation Acute Coronary Syndromes Are Associated With Adverse Outcomes: Analysis From the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) Trial

Study Questions:

What is the prognostic impact of intraprocedural thrombotic events (IPTEs) during percutaneous coronary intervention (PCI)?

Methods:

The authors evaluated the occurrence of IPTEs in 3,428 patients who underwent PCI for non–ST-segment elevation acute coronary syndrome in the ACUITY trial, and underwent detailed core laboratory angiographic analysis. An IPTE was defined as the development of new or increasing thrombus, abrupt vessel closure, no reflow, slow reflow, or distal embolization at any time during the procedure.

Results:

IPTE occurred in 121 patients (3.5%). Patients with IPTE were more likely to present with elevated biomarkers and less likely to be on prior statins. Compared with patients without IPTE, patients with IPTE had higher in-hospital (6.3% vs. 25.6%), 30-day (9.3% vs. 30.6%), and 1-year major adverse cardiac event rates (37% vs. 20.5%). There was no difference in the occurrence of IPTE in each of the three randomization arms. An IPTE was strongly associated with Q-wave myocardial infarction and out-of-laboratory definite/probable stent thrombosis. Occurrence of IPTE was associated with an increase in 30-day mortality (3.3% vs. 0.7%, p = 0.002). IPTE was an independent predictor of 30-day and 1-year composite death/myocardial infarction, stent thrombosis, and major adverse cardiac events.

Conclusions:

While uncommon, IPTE is associated with an increased risk of major adverse events including death, myocardial infarction, and stent thrombosis.

Perspective:

This important study highlights the strong adverse implications of IPTE. The occurrence of IPTE was associated with elevated biomarkers, and impaired myocardial blush at baseline. Further studies are warranted to assess if selective use of more potent antiplatelet therapy could be effective in reducing the occurrence and consequences of this complication.

Clinical Topics: Acute Coronary Syndromes, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, ACS and Cardiac Biomarkers, Nonstatins, Novel Agents, Statins, Interventions and ACS

Keywords: Myocardial Infarction, Acute Coronary Syndrome, Biological Markers, Thrombosis, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Percutaneous Coronary Intervention


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