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Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
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Angiographic thrombus burden classification in patients with ST-segment elevation myocardial infarction treated with

Georgios Sianos1, Michail I Papafaklis, Patrick W Serruys

  • 1Department of Cardiology, AHEPA University Hospital, Stilp. Kiriakidi 1, 54636 Thessaloniki, Greece. gsianos@auth.gr

The Journal of Invasive Cardiology
|October 16, 2010
PubMed

Insights

A new classification system for thrombus burden in ST-segment elevation myocardial infarction (STEMI) identifies large thrombus as a predictor of mortality. This grading system aids in risk stratification for adverse cardiac events.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Biomedical Engineering

Background:

  • Thrombus presence is linked to poor outcomes in ST-elevation myocardial infarction (STEMI).
  • Accurate assessment of thrombus burden (TB) is crucial for risk stratification and treatment planning.

Purpose of the Study:

  • To develop and validate a classification system for thrombus burden (TB) in patients with STEMI.
  • To evaluate the association between different TB grades and major adverse cardiac events (MACE).

Main Methods:

  • Retrospective analysis of 900 STEMI patients undergoing percutaneous coronary intervention.
  • Development of a 6-grade TB classification (G0-G5) based on vessel diameter, with reclassification for occluded vessels.
  • Kaplan-Meier analysis to assess 2-year MACE-free survival and Cox regression for independent predictors of mortality and MACE.

Main Results:

  • A total of 900 patients were analyzed, with 57.7% initially classified as G5 (unable to assess TB).
  • After reclassification, the distribution of TB grades was G0 (8.1%), G1 (19%), G2 (24.5%), G3 (16.6%), G4 (30%), and G5 (1.9%).
  • Large thrombus (G4) was an independent predictor of 2-year mortality (HR: 1.66) and MACE (HR: 2.04), while G0 also showed worse outcomes.

Conclusions:

  • A reliable classification system for thrombus burden in STEMI patients, including occluded arteries, has been developed.
  • Large thrombus burden (≥ 2 vessel diameters) is a significant independent predictor of mortality and MACE in STEMI.
  • This classification aids in identifying high-risk patients for improved clinical management.
Abstract

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