Angiographic characteristics of definite stent thrombosis: Role of thrombus grade, collaterals, epicardial coronary flow, and myocardial perfusion

Ryan R. Reeves, Mitul Patel, Ehrin J. Armstrong, Shiv Sab, Stephen W. Waldo, Khung Keong Yeo, Kendrick A. Shunk, Reginald Low, Jason H Rogers, Ehtisham Mahmud

Research output: Contribution to journalArticle

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Abstract

Objectives: To characterize the prevalence of thrombus burden, collateral vessels to the infarct-related artery, epicardial coronary artery flow, and myocardial perfusion in patients with angiographically confirmed definite stent thrombosis (ST), and to define their relationship with associated treatments and outcomes. Background: Angiographic characteristics of ST are not well defined. Methods: All cases of angiographically determined ST at five academic hospitals from 2005 to 2012 were reviewed. Demographic, procedural, and angiographic characteristics were recorded. In-hospital and 1-year follow-up data were obtained. Results: Among 205 cases of angiographic definite ST (60 ± 8 years; 87% male), the majority presented with late/very late ST (69%) and STEMI (66%). High-risk angiographic findings at presentation included thrombus grade 4-5 (87%), absence of collateral vessels (76%), and reduced initial TIMI 3 flow (90%). Final TIMI 3 flow was achieved in 90% of patients and was associated with greater use of aspiration thrombectomy (60% vs. 25%; P = 0.003), glycoprotein IIb/IIIa inhibitors (80% vs. 30%, P < 0.001), and repeat stenting (67% vs. 10%, P < 0.001). A final myocardial perfusion grade of 2-3 was achieved in 79% of patients and was associated with greater use of aspiration thrombectomy (61% vs. 36%, P = 0.003). After multivariable logistic regression, aspiration thrombectomy (AOR 2.6, 95% CI 1.3-5.2) and implantation of a new stent (AOR 2.1, 95% CI 1.1-4.3) were associated with optimal combined epicardial flow and myocardial perfusion. At 1-year followup, significantly lower risk of repeat ST (HR 0.1; 95% CI 0.1,0.2; P < 0.001) among patients with initial TIMI 3 flow at index ST was observed. Conclusions: The majority of ST patients present with late/very late ST with high thrombus burden and STEMI. Presence of collateral vessels and low thrombus burden is cardioprotective, while reduced initial TIMI flow is associated with larger infarct size and recurrent ST. Aspiration thrombectomy and repeat stenting are associated with improved epicardial coronary artery flow and myocardial perfusion among patients treated for ST.

Original languageEnglish (US)
Pages (from-to)13-22
Number of pages10
JournalCatheterization and Cardiovascular Interventions
Volume85
Issue number1
DOIs
StatePublished - Jan 1 2015

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Stents
Thrombosis
Perfusion
Thrombectomy
Coronary Vessels
P-Glycoprotein
Arteries
Logistic Models
Demography

Keywords

  • Angiographic characteristics
  • Collaterals
  • Myocardial perfusion
  • Stent thrombosis
  • Thrombus grade
  • TIMI flow

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Angiographic characteristics of definite stent thrombosis : Role of thrombus grade, collaterals, epicardial coronary flow, and myocardial perfusion. / Reeves, Ryan R.; Patel, Mitul; Armstrong, Ehrin J.; Sab, Shiv; Waldo, Stephen W.; Yeo, Khung Keong; Shunk, Kendrick A.; Low, Reginald; Rogers, Jason H; Mahmud, Ehtisham.

In: Catheterization and Cardiovascular Interventions, Vol. 85, No. 1, 01.01.2015, p. 13-22.

Research output: Contribution to journalArticle

Reeves, Ryan R. ; Patel, Mitul ; Armstrong, Ehrin J. ; Sab, Shiv ; Waldo, Stephen W. ; Yeo, Khung Keong ; Shunk, Kendrick A. ; Low, Reginald ; Rogers, Jason H ; Mahmud, Ehtisham. / Angiographic characteristics of definite stent thrombosis : Role of thrombus grade, collaterals, epicardial coronary flow, and myocardial perfusion. In: Catheterization and Cardiovascular Interventions. 2015 ; Vol. 85, No. 1. pp. 13-22.
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abstract = "Objectives: To characterize the prevalence of thrombus burden, collateral vessels to the infarct-related artery, epicardial coronary artery flow, and myocardial perfusion in patients with angiographically confirmed definite stent thrombosis (ST), and to define their relationship with associated treatments and outcomes. Background: Angiographic characteristics of ST are not well defined. Methods: All cases of angiographically determined ST at five academic hospitals from 2005 to 2012 were reviewed. Demographic, procedural, and angiographic characteristics were recorded. In-hospital and 1-year follow-up data were obtained. Results: Among 205 cases of angiographic definite ST (60 ± 8 years; 87{\%} male), the majority presented with late/very late ST (69{\%}) and STEMI (66{\%}). High-risk angiographic findings at presentation included thrombus grade 4-5 (87{\%}), absence of collateral vessels (76{\%}), and reduced initial TIMI 3 flow (90{\%}). Final TIMI 3 flow was achieved in 90{\%} of patients and was associated with greater use of aspiration thrombectomy (60{\%} vs. 25{\%}; P = 0.003), glycoprotein IIb/IIIa inhibitors (80{\%} vs. 30{\%}, P < 0.001), and repeat stenting (67{\%} vs. 10{\%}, P < 0.001). A final myocardial perfusion grade of 2-3 was achieved in 79{\%} of patients and was associated with greater use of aspiration thrombectomy (61{\%} vs. 36{\%}, P = 0.003). After multivariable logistic regression, aspiration thrombectomy (AOR 2.6, 95{\%} CI 1.3-5.2) and implantation of a new stent (AOR 2.1, 95{\%} CI 1.1-4.3) were associated with optimal combined epicardial flow and myocardial perfusion. At 1-year followup, significantly lower risk of repeat ST (HR 0.1; 95{\%} CI 0.1,0.2; P < 0.001) among patients with initial TIMI 3 flow at index ST was observed. Conclusions: The majority of ST patients present with late/very late ST with high thrombus burden and STEMI. Presence of collateral vessels and low thrombus burden is cardioprotective, while reduced initial TIMI flow is associated with larger infarct size and recurrent ST. Aspiration thrombectomy and repeat stenting are associated with improved epicardial coronary artery flow and myocardial perfusion among patients treated for ST.",
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author = "Reeves, {Ryan R.} and Mitul Patel and Armstrong, {Ehrin J.} and Shiv Sab and Waldo, {Stephen W.} and Yeo, {Khung Keong} and Shunk, {Kendrick A.} and Reginald Low and Rogers, {Jason H} and Ehtisham Mahmud",
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T1 - Angiographic characteristics of definite stent thrombosis

T2 - Role of thrombus grade, collaterals, epicardial coronary flow, and myocardial perfusion

AU - Reeves, Ryan R.

AU - Patel, Mitul

AU - Armstrong, Ehrin J.

AU - Sab, Shiv

AU - Waldo, Stephen W.

AU - Yeo, Khung Keong

AU - Shunk, Kendrick A.

AU - Low, Reginald

AU - Rogers, Jason H

AU - Mahmud, Ehtisham

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Objectives: To characterize the prevalence of thrombus burden, collateral vessels to the infarct-related artery, epicardial coronary artery flow, and myocardial perfusion in patients with angiographically confirmed definite stent thrombosis (ST), and to define their relationship with associated treatments and outcomes. Background: Angiographic characteristics of ST are not well defined. Methods: All cases of angiographically determined ST at five academic hospitals from 2005 to 2012 were reviewed. Demographic, procedural, and angiographic characteristics were recorded. In-hospital and 1-year follow-up data were obtained. Results: Among 205 cases of angiographic definite ST (60 ± 8 years; 87% male), the majority presented with late/very late ST (69%) and STEMI (66%). High-risk angiographic findings at presentation included thrombus grade 4-5 (87%), absence of collateral vessels (76%), and reduced initial TIMI 3 flow (90%). Final TIMI 3 flow was achieved in 90% of patients and was associated with greater use of aspiration thrombectomy (60% vs. 25%; P = 0.003), glycoprotein IIb/IIIa inhibitors (80% vs. 30%, P < 0.001), and repeat stenting (67% vs. 10%, P < 0.001). A final myocardial perfusion grade of 2-3 was achieved in 79% of patients and was associated with greater use of aspiration thrombectomy (61% vs. 36%, P = 0.003). After multivariable logistic regression, aspiration thrombectomy (AOR 2.6, 95% CI 1.3-5.2) and implantation of a new stent (AOR 2.1, 95% CI 1.1-4.3) were associated with optimal combined epicardial flow and myocardial perfusion. At 1-year followup, significantly lower risk of repeat ST (HR 0.1; 95% CI 0.1,0.2; P < 0.001) among patients with initial TIMI 3 flow at index ST was observed. Conclusions: The majority of ST patients present with late/very late ST with high thrombus burden and STEMI. Presence of collateral vessels and low thrombus burden is cardioprotective, while reduced initial TIMI flow is associated with larger infarct size and recurrent ST. Aspiration thrombectomy and repeat stenting are associated with improved epicardial coronary artery flow and myocardial perfusion among patients treated for ST.

AB - Objectives: To characterize the prevalence of thrombus burden, collateral vessels to the infarct-related artery, epicardial coronary artery flow, and myocardial perfusion in patients with angiographically confirmed definite stent thrombosis (ST), and to define their relationship with associated treatments and outcomes. Background: Angiographic characteristics of ST are not well defined. Methods: All cases of angiographically determined ST at five academic hospitals from 2005 to 2012 were reviewed. Demographic, procedural, and angiographic characteristics were recorded. In-hospital and 1-year follow-up data were obtained. Results: Among 205 cases of angiographic definite ST (60 ± 8 years; 87% male), the majority presented with late/very late ST (69%) and STEMI (66%). High-risk angiographic findings at presentation included thrombus grade 4-5 (87%), absence of collateral vessels (76%), and reduced initial TIMI 3 flow (90%). Final TIMI 3 flow was achieved in 90% of patients and was associated with greater use of aspiration thrombectomy (60% vs. 25%; P = 0.003), glycoprotein IIb/IIIa inhibitors (80% vs. 30%, P < 0.001), and repeat stenting (67% vs. 10%, P < 0.001). A final myocardial perfusion grade of 2-3 was achieved in 79% of patients and was associated with greater use of aspiration thrombectomy (61% vs. 36%, P = 0.003). After multivariable logistic regression, aspiration thrombectomy (AOR 2.6, 95% CI 1.3-5.2) and implantation of a new stent (AOR 2.1, 95% CI 1.1-4.3) were associated with optimal combined epicardial flow and myocardial perfusion. At 1-year followup, significantly lower risk of repeat ST (HR 0.1; 95% CI 0.1,0.2; P < 0.001) among patients with initial TIMI 3 flow at index ST was observed. Conclusions: The majority of ST patients present with late/very late ST with high thrombus burden and STEMI. Presence of collateral vessels and low thrombus burden is cardioprotective, while reduced initial TIMI flow is associated with larger infarct size and recurrent ST. Aspiration thrombectomy and repeat stenting are associated with improved epicardial coronary artery flow and myocardial perfusion among patients treated for ST.

KW - Angiographic characteristics

KW - Collaterals

KW - Myocardial perfusion

KW - Stent thrombosis

KW - Thrombus grade

KW - TIMI flow

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