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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Effects of different strategies on high thrombus burden in patients with ST-segment elevation myocardial infarction
Yuyang Xiao1, Xianghua Fu, Yanbo Wang
1Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
Insights
Intracoronary thrombolysis improved myocardial microcirculation perfusion more effectively than thrombus aspiration in ST-elevation myocardial infarction patients. Both strategies are safe for managing high coronary thrombus burden, with thrombolysis showing better long-term outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Research
Background:
- ST-elevation myocardial infarction (STEMI) with high thrombus burden requires effective reperfusion strategies.
- Assessing microcirculatory perfusion is crucial for predicting outcomes in STEMI patients.
Purpose of the Study:
- To compare the efficacy and safety of intracoronary thrombolysis (IT) versus thrombus aspiration (TA) in STEMI patients with high thrombus burden.
- To evaluate the impact of these interventions on myocardial perfusion using index of microcirculatory resistance (IMR) and single-photon emission computed tomography (SPECT).
Main Methods:
- A randomized trial involving STEMI patients undergoing primary percutaneous catheterization from January 2017 to January 2018.
- Patients were assigned to either TA or IT group, with assessments including IMR, SPECT, and major adverse cardiovascular events (MACEs) over 12 months.
Main Results:
- The IT group showed significantly better thrombus burden scores, corrected TIMI frame count, TIMI myocardial perfusion grade 3, and IMR post-recanalization compared to the TA group (P<0.05).
- Over 12 months, the IT group had significantly smaller infarct size (SPECT) and improved left ventricular ejection fraction, with a lower composite MACE rate compared to the TA group (P=0.046, P=0.043, P=0.034 respectively).
Conclusions:
- Both thrombus aspiration and intracoronary thrombolysis are safe and effective for high coronary thrombus burden in STEMI.
- Intracoronary thrombolysis demonstrates superior benefits in improving myocardial microcirculation perfusion and long-term cardiac function compared to thrombus aspiration.
Objective:
This study aimed at evaluating efficacy and safety of thrombus aspiration and intracoronary-targeted thrombolysis on coronary thrombus burden in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous catheterization, comparing their effects on myocardial perfusion through index of microcirculatory resistance (IMR) and single-photon emission computed tomography (SPECT).
Participants And Methods:
From January 2017 to January 2018, STEMI patients with high thrombus burden undergoing primary catheterization were enrolled and randomly assigned to receiving thrombus aspiration (TA group) or intracoronary thrombolysis (IT group). IMR, SPECT, and other conventional measurements were adopted to assess myocardial perfusion. Major adverse cardiovascular events (MACEs) and complications were recorded over a 90-day follow-up and a 12-month follow-up after the procedure.
Results:
The study consisted of 38 patients in the IT group and 33 in the TA group. After recanalization, thrombus burden score, corrected thrombolysis in myocardial infarction (TIMI) frame count, the proportion of TIMI myocardial perfusion 3 grade, and IMR in the IT group were significantly better than those of the TA group (P<0.05). During the 90-day follow-up, no difference was observed in cardiac function and MACEs. During the 12-month follow-up, there were significant differences in infarct size of SPECT (18.56±8.56 vs. 22.67±7.66, P=0.046), left ventricular ejection fraction of echocardiography (58.13±5.92 vs. 55.17±5.68, P=0.043), and the composite MACEs between the two groups (P=0.034).
Conclusion:
Thrombus aspiration and intracoronary-targeted thrombolysis are effective and safe strategies in managing high coronary thrombus burden in STEMI patients. Compared with aspiration, intracoronary-targeted thrombolysis is more beneficial in improving myocardial microcirculation perfusion.
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