Combined Primary PCI with Multiple Thrombus Burden Reduction Therapy Improved Cardiac Function in Patients with Acute...

Area of Science:

• Cardiology
• Interventional Cardiology
• Myocardial Infarction Research

Background:

• High thrombus burden during primary percutaneous coronary intervention (PCI) leads to poor outcomes, including slow-flow and no-reflow phenomena.
• Effective reduction of thrombus burden is crucial for improving microcirculation and long-term cardiac function after STEMI.

Purpose of the Study:

• To evaluate the efficacy of a combined thrombus burden reduction therapy compared to thrombus aspiration alone during primary PCI.
• To assess the impact on microcirculation and long-term cardiac function in anterior wall STEMI patients with high thrombus burden.

Main Methods:

• Randomized trial comparing combined therapy versus thrombus aspiration alone in STEMI patients.
• Primary endpoints included TIMI myocardial perfusion grade 3, ST-segment resolution >70%, index of microcirculatory resistance (IMR), and left ventricular ejection fraction (LVEF).
• Follow-up was conducted at 1 year, with cardiac function assessed at 3 months and 1 year.

Main Results:

• The combined therapy group showed significantly higher rates of TMPG 3 (68.2% vs 33.3%) and STR >70% (63.6% vs 25%).
• Index of microcirculatory resistance (IMR) was significantly lower in the combined group (31.50 U vs 62.72 U).
• Left ventricular ejection fraction (LVEF) was significantly better in the combined group at 3 months (42.1% vs 40.0%) and 1 year (41.9% vs 39.8%).
• IMR showed a negative correlation with LVEF at both 3 months and 1 year.

Conclusions:

• Combined thrombus burden reduction therapy during primary PCI is safe and effective in improving myocardial perfusion and cardiac function in STEMI patients.
• This approach successfully reduces thrombus burden and enhances microcirculation, leading to improved long-term outcomes.
• IMR serves as a valuable predictor for post-myocardial infarction cardiac function.