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Impact of Large Thrombus Burden on Very Long-Term Clinical Outcomes in Patients Presenting With ST-Segment Elevation

Paola Scarparo, Menno van Gameren, Jeroen Wilschut

  • 1Interventional Cardiology, Thoraxcenter, Erasmus MC, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. r.diletti@erasmusmc.nl.

The Journal of Invasive Cardiology
|November 4, 2021
PubMed

Insights

Large thrombus burden (LTB) in ST-segment elevation myocardial infarction (STEMI) patients increases early risks like no-reflow and distal embolization. However, LTB does not impact very long-term clinical outcomes or mortality after percutaneous coronary intervention.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Thrombosis Research

Background:

  • Large thrombus burden (LTB) is a recognized complication in ST-segment elevation myocardial infarction (STEMI).
  • The very long-term clinical impact of LTB in STEMI patients remains incompletely understood.
  • Previous studies have not extensively evaluated outcomes beyond 10 years post-intervention.

Purpose of the Study:

  • To compare very long-term clinical outcomes between STEMI patients with LTB and small thrombus burden (STB).
  • To assess the impact of LTB on major adverse cardiac events (MACE) and mortality up to 15 years post-percutaneous coronary intervention (PCI).
  • To identify potential early risks associated with LTB in STEMI patients.

Main Methods:

  • A cohort of 812 STEMI patients undergoing PCI between 2002-2004 was analyzed.
  • Thrombus burden (TB) was assessed, with LTB defined as thrombus ≥2 vessel diameters.
  • Outcomes including 10-year MACE and up to 15-year survival data were collected and analyzed.

Main Results:

  • Patients with LTB (28.0%) had higher rates of no-reflow and distal embolization compared to STB patients (72.0%).
  • No significant differences in 10-year MACE rates (42.5% vs 42.4%) or 10/15-year mortality were observed between LTB and STB groups.
  • LTB was an independent predictor of MACE within 30 days post-PCI, but not beyond.

Conclusions:

  • LTB in STEMI patients is associated with increased early procedural complications like no-reflow and distal embolization.
  • Despite early risks, LTB does not appear to influence very long-term MACE or mortality rates.
  • LTB may help identify a high-risk subpopulation for early ischemic events, warranting closer monitoring.
Abstract

Keywords:
ST-segment elevation myocardial infarctionmortalitythrombus burden

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