Older coronary thrombus is an independent predictor of 1-year mortality in acute myocardial infarction

Xiaofei Li; Miranda C. Kramer; Peter Damman; Allard C. van der Wal; Maik J. Grundeken; Jan P. van Straalen; Karel T. Koch; Jose P. Henriques; Jan Baan; Marije M. Vis; Jan J. Piek; Johan C. Fischer; Jan G. P. Tijssen; Robbert J. de Winter

doi:https://doi.org/10.1111/eci.12619

Older coronary thrombus is an independent predictor of 1-year mortality in acute myocardial infarction

Xiaofei Li, Miranda C. Kramer, Peter Damman, Allard C. van der Wal, Maik J. Grundeken, Jan P. van Straalen, Karel T. Koch, Jose P. Henriques, Jan Baan, Marije M. Vis, Jan J. Piek, Johan C. Fischer, Jan G. P. Tijssen, Robbert J. de Winter

Research output: Contribution to journal › Article › Academic › peer-review

9 Citations (Scopus)

Abstract

We have previously shown that older thrombus is associated with a twofold higher long-term mortality in ST-segment elevation myocardial infarction (STEMI) patients after primary percutaneous coronary intervention (pPCI). We evaluated whether the addition of the presence of older thrombus to a multimarker model would result in increased predictive power for 1-year mortality in STEMI patients. The study population (n = 1442) consists of STEMI patients treated with thrombus aspiration during pPCI. Patients were included if aspirated thrombus material could histopathologically be classified according to thrombus age (n = 870) and laboratory measurements of biomarkers (cardiac troponin T, glucose, N-terminal pro-brain natriuretic peptide, estimated glomerular filtration rate and C-reactive protein) were available. The additional prognostic value of the presence of older thrombus beyond multiple biomarkers and established clinical risk factors was evaluated using multivariate Cox regression models. Serum biomarker concentrations were similar between patients with fresh and older thrombus. Sixty patients (7%) died within 1 year. The presence of older thrombus remained strongly associated with mortality at 1 year after multivariable adjustment for multiple biomarkers and established clinical risk factors. Addition of older thrombus to either a model including clinical risk factors and biomarkers or a model including solely biomarkers resulted in significant increases in the discriminative value, evidenced by net reclassification improvement and integrated discriminative improvement. The presence of older thrombus provides independent complementary information to a multimarker model including established clinical risk factors and multiple biomarkers for predicting 1-year mortality in STEMI patients treated with pPCI and thrombus aspiration

Original language	English
Pages (from-to)	501-510
Journal	European journal of clinical investigation
Volume	46
Issue number	6
DOIs	https://doi.org/10.1111/eci.12619
Publication status	Published - 2016

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https://doi.org/10.1111/eci.12619

Cite this

Li, X., Kramer, M. C., Damman, P., van der Wal, A. C., Grundeken, M. J., van Straalen, J. P., Koch, K. T., Henriques, J. P., Baan, J., Vis, M. M., Piek, J. J., Fischer, J. C., Tijssen, J. G. P., & de Winter, R. J. (2016). Older coronary thrombus is an independent predictor of 1-year mortality in acute myocardial infarction. European journal of clinical investigation, 46(6), 501-510. https://doi.org/10.1111/eci.12619

@article{fdab74ff40a04feda2d65dd3fb4f558e,

title = "Older coronary thrombus is an independent predictor of 1-year mortality in acute myocardial infarction",

abstract = "We have previously shown that older thrombus is associated with a twofold higher long-term mortality in ST-segment elevation myocardial infarction (STEMI) patients after primary percutaneous coronary intervention (pPCI). We evaluated whether the addition of the presence of older thrombus to a multimarker model would result in increased predictive power for 1-year mortality in STEMI patients. The study population (n = 1442) consists of STEMI patients treated with thrombus aspiration during pPCI. Patients were included if aspirated thrombus material could histopathologically be classified according to thrombus age (n = 870) and laboratory measurements of biomarkers (cardiac troponin T, glucose, N-terminal pro-brain natriuretic peptide, estimated glomerular filtration rate and C-reactive protein) were available. The additional prognostic value of the presence of older thrombus beyond multiple biomarkers and established clinical risk factors was evaluated using multivariate Cox regression models. Serum biomarker concentrations were similar between patients with fresh and older thrombus. Sixty patients (7%) died within 1 year. The presence of older thrombus remained strongly associated with mortality at 1 year after multivariable adjustment for multiple biomarkers and established clinical risk factors. Addition of older thrombus to either a model including clinical risk factors and biomarkers or a model including solely biomarkers resulted in significant increases in the discriminative value, evidenced by net reclassification improvement and integrated discriminative improvement. The presence of older thrombus provides independent complementary information to a multimarker model including established clinical risk factors and multiple biomarkers for predicting 1-year mortality in STEMI patients treated with pPCI and thrombus aspiration",

author = "Xiaofei Li and Kramer, {Miranda C.} and Peter Damman and {van der Wal}, {Allard C.} and Grundeken, {Maik J.} and {van Straalen}, {Jan P.} and Koch, {Karel T.} and Henriques, {Jose P.} and Jan Baan and Vis, {Marije M.} and Piek, {Jan J.} and Fischer, {Johan C.} and Tijssen, {Jan G. P.} and {de Winter}, {Robbert J.}",

year = "2016",

doi = "https://doi.org/10.1111/eci.12619",

language = "English",

volume = "46",

pages = "501--510",

journal = "European journal of clinical investigation",

issn = "0014-2972",

publisher = "Wiley-Blackwell Publishing",

number = "6",

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Li, X, Kramer, MC, Damman, P, van der Wal, AC, Grundeken, MJ, van Straalen, JP, Koch, KT , Henriques, JP , Baan, J , Vis, MM , Piek, JJ , Fischer, JC , Tijssen, JGP & de Winter, RJ 2016, 'Older coronary thrombus is an independent predictor of 1-year mortality in acute myocardial infarction', European journal of clinical investigation, vol. 46, no. 6, pp. 501-510. https://doi.org/10.1111/eci.12619

TY - JOUR

T1 - Older coronary thrombus is an independent predictor of 1-year mortality in acute myocardial infarction

AU - Li, Xiaofei

AU - Kramer, Miranda C.

AU - Damman, Peter

AU - van der Wal, Allard C.

AU - Grundeken, Maik J.

AU - van Straalen, Jan P.

AU - Koch, Karel T.

AU - Henriques, Jose P.

AU - Baan, Jan

AU - Vis, Marije M.

AU - Piek, Jan J.

AU - Fischer, Johan C.

AU - Tijssen, Jan G. P.

AU - de Winter, Robbert J.

PY - 2016

Y1 - 2016

N2 - We have previously shown that older thrombus is associated with a twofold higher long-term mortality in ST-segment elevation myocardial infarction (STEMI) patients after primary percutaneous coronary intervention (pPCI). We evaluated whether the addition of the presence of older thrombus to a multimarker model would result in increased predictive power for 1-year mortality in STEMI patients. The study population (n = 1442) consists of STEMI patients treated with thrombus aspiration during pPCI. Patients were included if aspirated thrombus material could histopathologically be classified according to thrombus age (n = 870) and laboratory measurements of biomarkers (cardiac troponin T, glucose, N-terminal pro-brain natriuretic peptide, estimated glomerular filtration rate and C-reactive protein) were available. The additional prognostic value of the presence of older thrombus beyond multiple biomarkers and established clinical risk factors was evaluated using multivariate Cox regression models. Serum biomarker concentrations were similar between patients with fresh and older thrombus. Sixty patients (7%) died within 1 year. The presence of older thrombus remained strongly associated with mortality at 1 year after multivariable adjustment for multiple biomarkers and established clinical risk factors. Addition of older thrombus to either a model including clinical risk factors and biomarkers or a model including solely biomarkers resulted in significant increases in the discriminative value, evidenced by net reclassification improvement and integrated discriminative improvement. The presence of older thrombus provides independent complementary information to a multimarker model including established clinical risk factors and multiple biomarkers for predicting 1-year mortality in STEMI patients treated with pPCI and thrombus aspiration

AB - We have previously shown that older thrombus is associated with a twofold higher long-term mortality in ST-segment elevation myocardial infarction (STEMI) patients after primary percutaneous coronary intervention (pPCI). We evaluated whether the addition of the presence of older thrombus to a multimarker model would result in increased predictive power for 1-year mortality in STEMI patients. The study population (n = 1442) consists of STEMI patients treated with thrombus aspiration during pPCI. Patients were included if aspirated thrombus material could histopathologically be classified according to thrombus age (n = 870) and laboratory measurements of biomarkers (cardiac troponin T, glucose, N-terminal pro-brain natriuretic peptide, estimated glomerular filtration rate and C-reactive protein) were available. The additional prognostic value of the presence of older thrombus beyond multiple biomarkers and established clinical risk factors was evaluated using multivariate Cox regression models. Serum biomarker concentrations were similar between patients with fresh and older thrombus. Sixty patients (7%) died within 1 year. The presence of older thrombus remained strongly associated with mortality at 1 year after multivariable adjustment for multiple biomarkers and established clinical risk factors. Addition of older thrombus to either a model including clinical risk factors and biomarkers or a model including solely biomarkers resulted in significant increases in the discriminative value, evidenced by net reclassification improvement and integrated discriminative improvement. The presence of older thrombus provides independent complementary information to a multimarker model including established clinical risk factors and multiple biomarkers for predicting 1-year mortality in STEMI patients treated with pPCI and thrombus aspiration

U2 - https://doi.org/10.1111/eci.12619

DO - https://doi.org/10.1111/eci.12619

M3 - Article

C2 - 26988709

SN - 0014-2972

VL - 46

SP - 501

EP - 510

JO - European journal of clinical investigation

JF - European journal of clinical investigation

IS - 6

ER -