open access

Vol 24, No 1 (2017)
Original articles — Interventional cardiology
Published online: 2017-01-11
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Presence of multiple coronary angiographic characteristics for the diagnosis of acute coronary thrombus

Alok R. Amraotkar, Shahab Ghafghazi, Patrick J. Trainor, Charles W. Hargis, Affan B. Irfan, Shesh N. Rai, Aruni Bhatnagar, Andrew P. DeFilippis
DOI: 10.5603/CJ.a2017.0004
·
Pubmed: 28150291
·
Cardiol J 2017;24(1):25-34.

open access

Vol 24, No 1 (2017)
Original articles — Interventional cardiology
Published online: 2017-01-11

Abstract

Background: Coronary angiography is frequently employed to aid in the diagnosis of acute coronary thrombosis, but there is limited data to support its efficacy. The aim of the study was to evaluate sensitivity and specificity of five commonly used angiographic characteristics for diagnosis of acute coronary thrombosis: Ambrose complex lesion morphology; spherical, ovoid, or irregular filling defect; abrupt vessel cutoff; intraluminal staining; and any coronary filling defect.

Methods: Coronary angiography of 80 acute myocardial infarction or stable coronary artery disease subjects were assessed in blinded fashion, for the presence or absence of five angiographic characteristics. Only lesions of ≥ 10% stenosis were included in the analysis. Presence or absence of each angiographic characteristic was compared between lesions with or without the following study defined outcomes: 1) histologically confirmed thrombus, 2) highly probable thrombus, and 3) highly unlikely thrombus.

Results: A total of 323 lesions were evaluated. All studied angiographic characteristics were associated with histologically confirmed and highly probable thrombotic lesions vs. lesions not meeting criteria for these outcomes (p < 0.03), except for complex Ambrose morphology which was not associated with any of the study outcomes (p > 0.05). Specificity for identifying histologically confirmed or highly probable thrombotic lesion was high (92–100%), especially for spherical, ovoid, or irregular filling defect (99–100%) and intraluminal staining (99%). Sensitivity for identification of histologically confirmed or highly probable thrombotic lesions was low for all tested angiographic characteristics (17–60%).

Conclusions: The presence of spherical, ovoid, or irregular filling defect or intraluminal staining was highly suggestive of coronary thrombus. However, none of the evaluated angiographic characteristics were useful for ruling out the presence of coronary thrombus. If confirmed in an independent cohort, these angiographic characteristic will be of significant value in confirming the diagnosis of acute coronary thrombosis.  

Abstract

Background: Coronary angiography is frequently employed to aid in the diagnosis of acute coronary thrombosis, but there is limited data to support its efficacy. The aim of the study was to evaluate sensitivity and specificity of five commonly used angiographic characteristics for diagnosis of acute coronary thrombosis: Ambrose complex lesion morphology; spherical, ovoid, or irregular filling defect; abrupt vessel cutoff; intraluminal staining; and any coronary filling defect.

Methods: Coronary angiography of 80 acute myocardial infarction or stable coronary artery disease subjects were assessed in blinded fashion, for the presence or absence of five angiographic characteristics. Only lesions of ≥ 10% stenosis were included in the analysis. Presence or absence of each angiographic characteristic was compared between lesions with or without the following study defined outcomes: 1) histologically confirmed thrombus, 2) highly probable thrombus, and 3) highly unlikely thrombus.

Results: A total of 323 lesions were evaluated. All studied angiographic characteristics were associated with histologically confirmed and highly probable thrombotic lesions vs. lesions not meeting criteria for these outcomes (p < 0.03), except for complex Ambrose morphology which was not associated with any of the study outcomes (p > 0.05). Specificity for identifying histologically confirmed or highly probable thrombotic lesion was high (92–100%), especially for spherical, ovoid, or irregular filling defect (99–100%) and intraluminal staining (99%). Sensitivity for identification of histologically confirmed or highly probable thrombotic lesions was low for all tested angiographic characteristics (17–60%).

Conclusions: The presence of spherical, ovoid, or irregular filling defect or intraluminal staining was highly suggestive of coronary thrombus. However, none of the evaluated angiographic characteristics were useful for ruling out the presence of coronary thrombus. If confirmed in an independent cohort, these angiographic characteristic will be of significant value in confirming the diagnosis of acute coronary thrombosis.  

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Keywords

atherothrombosis, acute coronary thrombus, acute coronary syndrome, myocardial infarction, coronary angiography

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About this article
Title

Presence of multiple coronary angiographic characteristics for the diagnosis of acute coronary thrombus

Journal

Cardiology Journal

Issue

Vol 24, No 1 (2017)

Pages

25-34

Published online

2017-01-11

DOI

10.5603/CJ.a2017.0004

Pubmed

28150291

Bibliographic record

Cardiol J 2017;24(1):25-34.

Keywords

atherothrombosis
acute coronary thrombus
acute coronary syndrome
myocardial infarction
coronary angiography

Authors

Alok R. Amraotkar
Shahab Ghafghazi
Patrick J. Trainor
Charles W. Hargis
Affan B. Irfan
Shesh N. Rai
Aruni Bhatnagar
Andrew P. DeFilippis

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