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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
- Source :
- Scopus-Elsevier
- Publication Year :
- 2015
- Publisher :
- Europa Digital & Publishing, 2015.
-
Abstract
- 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.
- Subjects :
- Adult
Male
medicine.medical_specialty
Acute coronary syndrome
Time Factors
medicine.medical_treatment
Myocardial Infarction
Coronary Artery Disease
Coronary Angiography
Coronary artery disease
Percutaneous Coronary Intervention
Coronary thrombosis
Predictive Value of Tests
medicine
Humans
Prospective Studies
cardiovascular diseases
Thrombus
Acute Coronary Syndrome
Aged
Thrombectomy
medicine.diagnostic_test
Rupture, Spontaneous
business.industry
Coronary Thrombosis
Patient Selection
Percutaneous coronary intervention
Middle Aged
medicine.disease
Coronary Vessels
Plaque, Atherosclerotic
Surgery
Treatment Outcome
Angiography
Platelet aggregation inhibitor
Feasibility Studies
Female
Stents
Radiology
France
Cardiology and Cardiovascular Medicine
business
TIMI
Platelet Aggregation Inhibitors
Tomography, Optical Coherence
Subjects
Details
- Language :
- English
- ISSN :
- 1774024X
- Database :
- OpenAIRE
- Journal :
- Scopus-Elsevier
- Accession number :
- edsair.doi.dedup.....42cc3713878e5122d69739373a3bfb3f