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E V Vyshlov1, A L Krylov, A G Syrkina

  • 1Сardiology Research Institute, Tomsk National Research Medical Centre; Siberian State Medical University.. fake@neicon.ru.

Kardiologiia
|March 12, 2019
PubMed
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A delayed one-day percutaneous coronary intervention (PCI) approach for acute myocardial infarction (MI) with massive coronary thrombosis showed safe and effective thrombus regression. This strategy reduced the risk of no-reflow phenomenon in patients with acute MI.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Thrombosis Research

Background:

  • Massive coronary thrombosis in acute myocardial infarction (MI) presents treatment challenges.
  • Immediate percutaneous coronary intervention (PCI) may risk no-reflow phenomenon due to thrombus burden.

Purpose of the Study:

  • To evaluate the safety and angiographic efficacy of a two-stage revascularization strategy.
  • To assess the impact of a one-day delay in PCI for patients with acute MI and massive coronary thrombosis.

Main Methods:

  • Study included 12 patients with massive coronary artery thrombus (length > 3x vessel diameter) and TIMI grade II-III flow.
  • Emergency PCI was deferred; patients received conservative antithrombotic therapy for 24 hours.
  • Repeat coronary angiography (CAG) was performed after 24 hours.

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Main Results:

  • Repeat CAG demonstrated thrombus regression in all patients: complete lysis in 8, partial lysis in 4.
  • PCI with stenting was successfully performed in 11 patients without complications.
  • No-reflow phenomenon or recurrent MI was observed in any patient.

Conclusions:

  • A 24-hour delay of PCI with initial conservative antithrombotic therapy is a safe tactic for acute MI with massive coronary thrombosis.
  • This staged approach may reduce the incidence of the no-reflow phenomenon.
  • Repeat CAG-guided stenting of residual stenosis is effective and safe.