Residual atherothrombotic burden after primary percutaneous coronary intervention and myocardial reperfusion-An...

Area of Science:

• Cardiovascular Imaging
• Interventional Cardiology
• Thrombosis Research

Background:

• Residual atherothrombotic burden (ATB) after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) has an unclear impact on myocardial reperfusion.
• Optimizing reperfusion is critical for improving clinical outcomes in STEMI patients.

Purpose of the Study:

• To assess the relationship between residual in-stent ATB, measured by optical frequency domain imaging (OFDI), and myocardial blush grade (MBG) after primary PCI.
• To compare different OFDI measurement methods for determining ATB and their correlation with MBG.

Main Methods:

• Prospective study of 60 STEMI patients pretreated with aspirin and ticagrelor.
• Residual ATB assessed using OFDI volumetric quantification (planimetry) and a semiquantitative thrombus score.
• Patients categorized by final myocardial blush grade (MBG ≥ 3 vs. < 3).

Main Results:

• Residual ATB was significantly lower in patients with good myocardial reperfusion (MBG ≥ 3) compared to those with impaired reperfusion (< 3).
• This finding held true across different OFDI measurement methods (quantification per frame, per millimeter, and semiquantitative thrombus score).
• Mean ATB was 10.08 ± 5.21%, with lower values observed in the MBG ≥ 3 group.

Conclusions:

• Substantial residual atherothrombotic burden persists after primary PCI in STEMI patients, even with dual antiplatelet therapy.
• Residual ATB is a significant correlate of suboptimal myocardial reperfusion.
• Addressing residual ATB may be crucial for improving clinical outcomes in STEMI.