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Impact of thrombus burden on procedural and mid-term outcomes after primary percutaneous coronary intervention

David Martí1, Luisa Salido, José L Mestre

  • 1Interventional Cardiology Unit, Department of Cardiology, Ramón y Cajal Hospital, University of Alcalá, Madrid, Spain.

Coronary Artery Disease
|October 30, 2015
PubMed

Insights

Large thrombus burden (TB) in ST-segment elevation myocardial infarction patients does not predict worse cardiac events after primary percutaneous coronary intervention. However, large TB is linked to larger infarct size, suggesting tailored therapies may improve outcomes.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Acute Coronary Syndromes

Background:

  • Angiographic thrombus burden (TB) assessment is crucial for guiding interventions in ST-segment elevation myocardial infarction (STEMI).
  • Early evaluation of TB can inform treatment decisions and potentially impact patient outcomes.

Purpose of the Study:

  • To investigate the impact of angiographic thrombus burden on cardiac events following primary percutaneous coronary intervention (PCI).
  • To analyze the association between large TB and outcomes such as death, reinfarction, or target vessel revascularization.

Main Methods:

  • A prospective study included 480 STEMI patients undergoing primary PCI.
  • Large TB was defined by thrombus length (≥2 vessel diameters) or aspiration characteristics.
  • Primary outcome was a composite of death, reinfarction, or target vessel revascularization.

Main Results:

  • 47% of patients had large TB, associated with more abciximab use, angiographic complications, and larger infarct sizes (peak troponin I).
  • Mid-term follow-up (19 months) showed similar rates of the primary composite outcome between small and large TB groups (16.2% vs. 12.8%).
  • No significant difference in definite stent thrombosis rates was observed between groups.

Conclusions:

  • Large angiographic thrombus burden in STEMI is associated with increased infarct size but not with worse mid-term cardiac outcomes after primary PCI.
  • Selective use of adjuvant therapies based on TB assessment may effectively reduce thrombotic complications.
Abstract

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