Percutaneous coronary intervention in native vessels with angiographically visible thrombus: Temporal trends and impact of drug-eluting stents

Objectives The aim of our study was to evaluate the temporal trends in outcomes following percutaneous coronary intervention in lesions with angiographically visible thrombus and to assess the impact of drug-eluting stents (DES) on long-term outcomes. Background Percutaneous coronary intervention in the presence of angiographically visible thrombus is associated with worse clinical outcomes. Whether recent advances in devices and adjunctive pharmacotherapy have made any significant impact on clinical outcomes is unknown. Moreover, concerns have been raised about the safety of DES in thrombotic lesions. Methods We conducted a retrospective analysis of 6,227 consecutive patients who had angiographically visible thrombus. Patients were grouped into 3 eras depending on the dominant interventional strategy of that time: early stent era (1990 to 1996), bare-metal stent era (1997 to 2003), and DES era (2003 to 2006). Results Procedural success rates, although much improved, have remained unchanged in the last 2 cohorts (43%, 85%, 86%; p < 0.001). Adjusted in-hospital mortality (4.7%, 3.0%, 3.6%; p < 0.001), and major adverse cardiovascular events (7.8%, 5.0%, 5.3%; p < 0.001) decreased modestly. During long-term follow-up, mortality and the combined end point of death or myocardial infarction were similar in the 3 cohorts; but the combined end point of death, myocardial infarction, or target lesion revascularization (p < 0.001) was lower in the 2 most recent eras. Conclusions There has been a marked improvement in procedural success accompanied by a reduction in in-hospital mortality and major adverse cardiac event rates. Importantly, the introduction of DES has not been associated with a greater risk of death or myocardial infarction among patients with angiographically visible thrombus.