Invasive management without stents in selected acute coronary syndrome patients with a large thrombus burden: a prospective study of optical coherence tomography guided treatment decisions

Article English OPEN
Souteyrand, Geraud ; Amabile, Nicolas ; Combaret, Nicolas ; Hammas, Sami ; Prati, Francesco ; Berry, Colin ; Pereira, Bruno ; Lusson, Jean-Rene ; Caussin, Christophe ; Motreff, Pascal (2015)
  • Publisher: Europa Digital & Publishing
  • Related identifiers: doi: 10.4244/eijy14m07_18
  • Subject:
    mesheuropmc: cardiovascular diseases

Aims: To assess whether a strategy of invasive management without stents in selected acute coronary syndrome (ACS) patients with a large thrombus burden (LTB) might be feasible and safe.\ud \ud Methods and results: We performed a prospective non-randomised observational cohort study of invasive treatment decisions guided by optical coherence tomography (OCT) in selected ACS patients with LTB. Among 852 ACS patients who had undergone invasive coronary angiography, 101 (11.8%) patients with large thrombus burden on initial angiography underwent thrombectomy to restore TIMI 3 flow without stenting. All of these patients then had repeat angiography with OCT (days 0-2 [Group 1], days 3-6 [Group 2] or days 7-30 [Group 3]). No adverse events occurred between the initial and second angiograms. Residual thrombus was detected in 68% of patients with OCT (respectively, 94%, 79% and 32% in Group 1, Group 2 and Group 3), and 20% of cases with angiography. Plaque rupture was detected by OCT in 65% of cases. Minimal lumen area was 2.81 mm2, 3.40 mm2 and 4.89 mm2 in Group 1, Group 2 and Group 3, respectively. Sixty-two percent of patients were stented (respectively, 76%, 61% and 50%). During a minimum follow-up period of 12 months in all patients, one non-fatal MI occurred and one PCI was performed for angina.\ud \ud Conclusions: Medical management without stents is safe and feasible in selected ACS patients with LTB. OCT revealed culprit lesion characteristics that were not disclosed by angiography and facilitated treatment decisions.
  • References (37)
    37 references, page 1 of 4

    Steg PG, James SK, Atar D, Badano LP, Blömstrom-Lundqvist C, Borger MA, Mario C Di, Dickstein K, Ducrocq G, Fernandez-Aviles F, Gershlick AH, Giannuzzi P, Halvorsen S, Huber K, Juni P, Kastrati A, Knuuti J, Lenzen MJ, Mahaffey KW, Valgimigli M, Hof A van 't, Widimsky P, Zahger D. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012;33:2569-2619.

    Kushner FG, Hand M, Smith SC Jr, King SB 3rd, Anderson JL, Antman EM, Bailey SR, Bates ER, Blankenship JC, Casey DE Jr, Green LA, Hochman JS, Jacobs AK, Krumholz HM, Morrison DA, Ornato JP, Pearle DL, Peterson ED, Sloan MA, Whitlow PL, Williams DO. 2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2009;54:2205-2241.

    Puymirat E, Simon T, Steg PG, Schiele F, Guéret P, Blanchard D, Khalife K, Goldstein P, Cattan S, Vaur L, Cambou J-P, Ferrières J, Danchin N. Association of changes in clinical characteristics and management with improvement in survival among patients with ST-elevation myocardial infarction. Jama J Am Med Assoc. 2012;308:998-1006.

    Degeare VS, Dangas G, Stone GW, Grines CL. Interventional procedures in acute myocardial infarction. Am Heart J. 2001;141:15-24.

    Singh M, Berger PB, Ting HH, Rihal CS, Wilson SH, Lennon RJ, Reeder GS, Bresnahan JF, Holmes Jr. DR. Influence of coronary thrombus on outcome of percutaneous coronary angioplasty in the current era (the Mayo Clinic experience). Am J Cardiol. 2001;88:1091-1096.

    White CJ, Ramee SR, Collins TJ, Escobar AE, Karsan A, Shaw D, Jain SP, Bass TA, Heuser RR, Teirstein PS, Bonan R, Walter PD, Smalling RW. Coronary thrombi increase PTCA risk. Angioscopy as a clinical tool. Circulation. 1996;93:253-258.

    Sianos G, Papafaklis MI, Daemen J, Vaina S, Mieghem CA van, Domburg RT van, Michalis LK, Serruys PW. Angiographic stent thrombosis after routine use of drugeluting stents in ST-segment elevation myocardial infarction: the importance of thrombus burden. J Am Coll Cardiol. 2007;50:573-583.

    10. Cook S, Wenaweser P, Togni M, Billinger M, Morger C, Seiler C, Vogel R, Hess O, Meier B, Windecker S. Incomplete stent apposition and very late stent thrombosis after drug-eluting stent implantation. Circulation. 2007;115:2426-2434.

    11. Cook S, Eshtehardi P, Kalesan B, Räber L, Wenaweser P, Togni M, Moschovitis A, Vogel R, Seiler C, Eberli FR, Lüscher T, Meier B, Jüni P, Windecker S. Impact of incomplete stent apposition on long-term clinical outcome after drug-eluting stent implantation. Eur Heart J [Internet]. 2012 [cited 2012 May 13]; Available from:

    12. Barlis P, Gonzalo N, Mario C Di, Prati F, Buellesfeld L, Rieber J, Dalby MC, Ferrante G, Cera M, Grube E, Serruys PW, Regar E. A multicentre evaluation of the safety of intracoronary optical coherence tomography. Eurointervention J Eur Collab Work Group Interv Cardiol Eur Soc Cardiol. 2009;5:90-95.

  • Metrics
    No metrics available
Share - Bookmark