Coronary thrombi increase PTCA risk - Angioscopy as a clinical tool
Coronary thrombi increase PTCA risk - Angioscopy as a clinical tool
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DOI：
10.1161/01.cir.93.2.253
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发表时间：
1996-01-15
期刊：
影响因子：
37.8
通讯作者：
Smalling, RW
中科院分区：
文献类型：
--
作者：
White, CJ;Ramee, SR;Smalling, RW
背景冠状动脉血管成形术后冠状动脉内血栓的存在与并发症的发生密切相关。已证明血管造影术在检测冠状动脉内形态的细微细节（如冠状动脉内血栓）方面不如血管镜检查灵敏。血栓检测血管镜检查，但不通过血管造影术的临床重要性是未知的。方法和结果经皮冠状动脉血管镜检查进行了122例接受常规冠状动脉球囊成形术（PTCA）在6个医疗中心。不稳定型心绞痛95例（78%），稳定型心绞痛27例（22%）。治疗不受血管镜检查结果的指导，没有患者接受溶栓治疗作为血管成形术的辅助治疗。通过血管镜检查在74处靶病变（61%）中发现了冠状动脉血栓，而通过血管造影仅发现24处（20%）。74名患有血管镜冠状动脉内血栓的患者中有10名（14%）发生了重大院内并发症（死亡、心肌梗死或紧急旁路手术），而48名无血栓的患者中只有1名（2%）发生了重大院内并发症（P= 0.03）。74例有血管镜冠状动脉内血栓的患者中有19例（26%）发生了院内复发性缺血（复发性心绞痛、重复PTCA或突然闭塞），而48例无血栓的患者中仅5例（10%）发生了院内复发性缺血（P= 0.03）。相对风险分析表明，血管镜血栓与不良结局密切相关（主要并发症或复发性缺血事件）（相对危险度，3.11; 95%CI，1.28 - 7.60; P= 0.01），血管造影血栓与这些并发症无关（相对危险度0.85; 95%CI 0.36 ~ 2.00; P= 0.91）结论冠状动脉狭窄相关的冠状动脉内血栓的存在被血管造影显著低估。血管镜下冠状动脉内血栓，其中大部分未被血管造影检测到，与冠状动脉血管成形术后不良结局的发生率增加相关。
Background The presence of angiographically identified intracoronary thrombus has been variably associated with complications after coronary angioplasty. Angiography has been shown to be less sensitive than angioscopy for detecting subtle details of intracoronary morphology, such as intracoronary thrombi. The clinical importance of thrombi detectable by angioscopy but not by angiography is not known.Methods and Results Percutaneous coronary angioscopy was performed in 122 patients undergoing conventional coronary balloon angioplasty (PTCA) at six medical centers. Unstable angina was present in 95 patients (78%) and stable angina in 27 (22%). Therapy was not guided by angioscopic findings, and no patient received thrombolytic therapy as an adjunct to angioplasty. Coronary thrombi were identified in 74 target lesions (61%) by angioscopy versus only 24 (20%) by angiography. A major in-hospital complication (death, myocardial infarction, or emergency bypass surgery) occurred in 10 of 74 patients (14%) with angioscopic intracoronary thrombus, compared with only 1 of 48 patients (2%) without thrombi (P=.03). In-hospital recurrent ischemia (recurrent angina, repeat PTCA, or abrupt occlusion) occurred in 19 of 74 patients (26%) with angioscopic intracoronary thrombi versus only 5 of 48 (10%) without thrombi (P=.03). Relative risk analysis demonstrated that angioscopic thrombus was strongly associated with adverse outcomes (either a major complication or a recurrent ischemic event) after PTCA (relative risk, 3.11; 95% CI, 1.28 to 7.60; P=.01) and that angiographic thrombi were not associated with these complications (relative risk, 0.85; 95% CI, 0.36 to 2.00; P=.91).Conclusions The presence of intracoronary thrombus associated with coronary stenoses is significantly underestimated by angiography. Angioscopic intracoronary thrombi, the majority of which were not detected by angiography, are associated with an increased incidence of adverse outcomes after coronary angioplasty.