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Published on: May 14, 2013
[Stent-delayed implantation strategy of acute myocardial infarction with high thrombus burden in primary percutaneous
Xinqun Hu1, Zhenjiang Liu, Zhenfei Fang
1Department of Cardiology, Second Xiangya Hospital, Central South University, Changsha 410011, China. huxinqungs@hotmail.com
Insights
Delayed stent implantation improves myocardial perfusion in acute myocardial infarction (AMI) patients with high thrombus burden after initial thrombus removal. This strategy enhances outcomes when intensive anti-thrombosis therapy is administered.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction
Background:
- High thrombus burden in acute myocardial infarction (AMI) poses challenges for reperfusion.
- Thrombus extraction is a crucial initial step, but residual thrombus may impact outcomes.
- Optimal timing for stent implantation after thrombus extraction requires further investigation.
Purpose of the Study:
- To evaluate the efficacy of delayed stent implantation versus direct stenting in AMI patients with high thrombus burden after initial thrombus extraction.
Main Methods:
- Retrospective analysis of 186 AMI patients; 56 with thrombus score (TS) ≥2 were included.
- Patients were divided into direct stenting (TS=0 or 1 post-extraction) and delayed stenting (TS ≥2 post-extraction) groups.
- Coronary artery flow and myocardial perfusion were assessed using Thrombolysis in Myocardial Infarction (TIMI) flow grade and TIMI myocardial perfusion (TMP) score.
Main Results:
- TIMI flow grade was not significantly different between groups (P=0.07).
- TMP score was significantly lower in the direct stenting group compared to the delayed stenting group (P<0.05).
- Delayed stenting demonstrated superior myocardial perfusion despite intensive anti-thrombosis therapy.
Conclusions:
- Delayed stent implantation significantly improves myocardial perfusion in AMI patients with high residual thrombus burden.
- This strategy is beneficial when intensive anti-thrombosis therapy is administered post-thrombus extraction.
- Consideration of delayed stenting may optimize microvascular function in selected AMI patients.
Objective:
To retrospectively evaluate the efficacy of stent-delayed implantation in patients with acute myocardial infarction (AMI) with high thrombus burden after thrombus extraction was performed.
Methods:
Of 186 consecutive AMI patients, 56 were included according to thrombus score(TS)>or=2, and then were divided into 2 groups based on the thrombus score after thrombus extraction was executed: the stent-direct implantation group (TS=0 or 1)and the stent-delayed implantation group (TS>or=2) even if 3 times thrombus extraction were given. Thrombolysis in myocardial infarction(TIMI)flow grade and TIMI myocardial perfusion (TMP) were used to assess the coronary artery flow and myocardial perfusion,respectively.
Results:
TIMI score in the stent-direct implantation group was lower than that in the stent-delayed implantation group. There was no significant difference(P=0.07). TMP score in the stent-direct implantation group was significantly lower than that in the stent-delayed implantation group (P<0.05).
Conclusion:
Stent-delayed implantation can remarkably improve myocardial perfusion in AMI patients with high thrombus burden after thrombus extraction and intensive anti-thrombosis therapy is administrated.
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