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Determinants of angiographic thrombus burden in patients with ST-segment elevation myocardial infarction

Ibrahim Halil Tanboga1, Selim Topcu2, Enbiya Aksakal2

  • 1Department of Cardiology, Ataturk University Medical School, Erzurum, Turkey haliltanboga@yahoo.com.

Clinical and Applied Thrombosis/Hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
|March 30, 2013
PubMed

Insights

Increased red cell distribution width (RDW) is a key predictor of high thrombus burden in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI). This finding highlights RDW

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Hematology

Background:

  • ST-elevation myocardial infarction (STEMI) poses a significant cardiovascular risk.
  • Assessing thrombus burden is crucial for successful primary percutaneous coronary intervention (pPCI).
  • Determinants of angiographic thrombus burden in STEMI patients require further investigation.

Purpose of the Study:

  • To identify the clinical, laboratory, and demographic factors predicting angiographic thrombus burden in STEMI patients undergoing pPCI.
  • To evaluate the association between baseline hematologic indices and thrombus burden.
  • To determine independent predictors of high thrombus burden.

Main Methods:

  • A cohort of 662 nonanemic STEMI patients undergoing pPCI was analyzed.
  • Clinical, laboratory, and demographic data were collected, including baseline hematologic indices.
  • Angiographic thrombus burden was assessed using Thrombolysis in Myocardial Infarction (TIMI) thrombus grades; high thrombus burden was defined as TIMI grades 4 and 5.

Main Results:

  • Patients with high thrombus burden exhibited more family history of coronary artery disease, longer pain-to-balloon times, higher Killip class, elevated neutrophil-to-lymphocyte ratio, higher red cell distribution width (RDW), and increased cardiac biomarkers.
  • High thrombus burden was associated with longer lesions, less direct stenting, poorer epicardial and myocardial perfusion, and more distal embolization and no-reflow.
  • Multivariate analysis identified RDW as the sole independent predictor of high thrombus burden (OR: 1.29, P < .001), with an AUC of 0.733 for predicting high TIMI thrombus burden.

Conclusions:

  • High thrombus burden in STEMI patients undergoing pPCI is linked to impaired perfusion and increased no-reflow and distal embolization.
  • Elevated red cell distribution width (RDW) is an independent predictor of coronary thrombus burden in these patients.
  • RDW may serve as a valuable biomarker for assessing thrombus burden in STEMI.
Abstract

Keywords:
ST-elevation myocardial infarctionprimary percutaneous coronary interventionthrombus burden

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