Author + information
- Min Gyu Kanga,b,
- Jong-Hwa Ahna,b,
- Jeong Yoon Janga,b,
- Hyun Woong Parka,b,
- Jin-Sin Koha,b,
- Jeong-Rang Parka,b,
- Yongwhi Parka,b,
- Seok-Jae Hwanga,b,
- Choong Hwan Kwaka,b,
- Jin-Yong Hwanga,b and
- Young-Hoon Jeonga,b
Background: “Platelet-Fibrin Clot Strength” is considered an absolute strength of the hemostatic plug and has a potential to increase in-stent restenosis (ISR). There are no studies to evaluate this issue after DES.
Methods: We prospectively enrolled DES-treated patients who underwent follow-up angiography due to cardiac symptom and/or sign (n=289). “Clot Strength” was assessed by thromboelastography (TEG®)-maximal amplitude (MAthrombin) and platelet reactivity was evaluated with VerifyNow.
Results: The 88 patients (30.4%) had ISR (> 50% diameter stenosis). There was no difference in VerifyNow-PRU between patients with vs. without ISR (p=0.608). ISR patients showed a higher level of TEG®-MAthrombin compared with no ISR patients (67.2±7.2 vs. 63.8±9.7 mm; p=0.003). ISR risk was increased proportionally according to TEG®-MAthrombin quartile (p< 0.001). In multivariate analysis, the highest quartile of TEG®-MAthrombin (> 70.0mm) was a main predictor for ISR (OR: 5.13; 95% CI: 1.49 – 17.54; p= 0.010) (Figure). When comparing predictive ROC curves, biochemical model showed the better discriminative power than angiographic model (C-statistic: 0.772 vs. 0.685; p= 0.032). Furthermore, combined model (C-statistic: 0.796) did not improve risk stratification compared with biochemical model alone (p= 0.260).
Conclusions: This is the first study to show the impact of “Clot Strength” on ISR in DES-treated patients. Biochemical risk factors would be more important than angiographic characteristics.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Coronary Angiography, Intra-Vascular Imaging, Revascularization and Outcomes
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1166-333
- 2017 American College of Cardiology Foundation