Absence of coronary angioscopy-derived in-stent thrombi is associated with major bleeding events in acute myocardial infarction

Akihito Ohgaku, Daisuke Fukamachi, Kurara Takahashi, Ran Tamiya, Shohei Migita, Saki Mizobuchi, Masatsugu Miyagawa, Yutaka Koyama, Hidesato Fujito, Riku Arai, Yasunari Ebuchi, Suguru Migita, Tomoyuki Morikawa, Masaki Monden, Norio Takei, Takehiro Tamaki, Keisuke Kojima, Naotaka Akutsu, Nobuhiro Murata, Daisuke KitanoYasuo Okumura

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Background and aims: The optimal duration of dual antiplatelet therapy for acute myocardial infarction is controversial because the bleeding risk outweighs the thromboembolic risk. We hypothesized that an in-stent thrombus (IS-thrombus) detected by coronary angioscopy (CAS) after stent implantation would be associated with high bleeding risk. Methods: This study included 208 patients who underwent CAS at 2 weeks after stent implantation for an acute myocardial infarction. The study was approved by the ethics committee at the Nihon University Itabashi Hospital (reference number RK-200714-10). Results: In 84 patients, in whom no IS-thrombus was identified in the culprit vessel using CAS, the major bleeding event rate was significantly higher than that in patients with IS-thrombi (n = 124). However, no difference was detected in major adverse cardiovascular events (MACE; stroke, hospitalization for a non-fatal myocardial infarction/unstable angina, target lesion revascularization, and cardiovascular death). After adjustments by the propensity score based on patient characteristics, the absence of IS-thrombi remained an independent predictor of major bleeding events (hazard ratio 4.73, 95% confidence interval 2.04–11.00, p < 0.001). Conclusions: The absence of CAS-detected IS-thrombi in the subacute phase was independently associated with future major bleeding events, but not with MACE. These findings may help optimize the duration of dual antiplatelet therapy.

Original languageEnglish
Pages (from-to)62-71
Number of pages10
Publication statusPublished - Feb 2021


  • Bleeding events
  • Coronary angioscopy
  • Japanese ST elevation Patient


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