Intraprocedural thrombotic events
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: IPTE
Overview
Intraprocedural thrombotic events (IPTE) are a rare group of acute ischemic complications that occur during percutaneous coronary interventions (PCI). Although by definition IPTE should occur before the end of the PCI procedure; it can however come about before or after stent-placement during PCI. In contrast to other complications that might occur before or after PCI, IPTE has recently been recognized as a special category of complications that include distinctive risk factors, associated patient and procedural characteristics, and most importantly comprises a unique predictor of periprocedural and postprocedural adverse clinical outcomes and overall patient prognosis. As such, the emergent objective understanding of IPTE and its reproducible effects is expected to render IPTE as a clinical end-point in PCI rather than a mere intraprocedural observation.[1][2]
Classification
- New thrombus formation
- Increased thrombus size
- Abrupt vessel closure
- No reflow phenomenon (new TIMI flow grade 0 or 1)
- Slow reflow phenomenon (new TIMI flow grade 2)
- Distal embolization
- Loss of side branch
- Intraprocedural stent thrombosis (IPST)
Epidemiology and Demographics
- The overall rate of IPTE is currently estimated to be 3.5-11.4% of all PCI procedures.
- In 2012, McEntegart et al. performed frame-by-frame analysis for 3,428 patients with non-ST elevation acute coronary syndrome (NSTEACS) previously enrolled in the ACUITY trial (Acute Catherterization and Urgent Intervention Triage Strategy). The total incidence of IPTE was 3.5% with varying rates of occurrence among specific etiologies of IPTE. 89.3% of all IPTE occurred at the level of a main branch.[2]
- Similarly in 2012, Pride et al. evaluated 1,452 high-risk patients with NSTTEAS enrolled in the EARLY ACS trial (Early Glycoprotein IIb/IIIa in Non-ST-Segment Elevation Acute Coronary Syndrome ) who underwent angiographic assessment. Incidence of IPTE was 11.4%.[1]
- In contrast to McEntegart, the study by Pride et al. included high-risk patients only. High-risk criteria were defined by the authors as having at least two of the following: Ischemic changes on electrocardiography (ECG), elevated cardiac enzyme, advanced age ≥ 60 years or age between 50-59 with documented coronary artery disease, cerebrovascular disease, or peripheral vascular disease. It is uncertain whether the inclusion criteria played a role in the increase of IPTE rates in the study as compared to McEntegart’s findings.[1]
References
- ↑ 1.0 1.1 1.2 Pride YB, Mohanavelu S, Zorkun C, Kunadian V, Giugliano RP, Newby LK; et al. (2012). "Association between angiographic complications and clinical outcomes among patients with acute coronary syndrome undergoing percutaneous coronary intervention: an EARLY ACS (Early Glycoprotein IIb/IIIa Inhibition in Non-ST-Segment Elevation Acute Coronary Syndrome) angiographic substudy". JACC Cardiovasc Interv. 5 (9): 927–35. doi:10.1016/j.jcin.2012.05.007. PMID 22995880.
- ↑ 2.0 2.1 McEntegart MB, Kirtane AJ, Cristea E, Brener S, Mehran R, Fahy M; et al. (2012). "Intraprocedural thrombotic events during percutaneous coronary intervention in patients with non-ST-segment elevation acute coronary syndromes are associated with adverse outcomes: analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial". J Am Coll Cardiol. 59 (20): 1745–51. doi:10.1016/j.jacc.2012.02.019. PMID 22575311.