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Adjunctive Catheter-Directed Thrombolysis during Primary PCI for ST-Segment Elevation Myocardial Infarction with High

Satsuki Noma1,2, Hideki Miyachi1,2, Isamu Fukuizumi1,2

  • 1Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo 113-8603, Japan.

Journal of Clinical Medicine
|January 11, 2022
PubMed

Insights

Catheter-directed thrombolysis (CDT) with tissue plasminogen activator is safe for ST-segment elevation myocardial infarction (STEMI) patients with high thrombus burden. It may be a valuable option when aspiration thrombectomy is unsuccessful.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Acute Coronary Syndromes

Background:

  • High coronary thrombus burden in ST-segment elevation myocardial infarction (STEMI) is linked to poor patient outcomes.
  • Optimal management strategies for STEMI with high thrombus burden remain undetermined.

Purpose of the Study:

  • To evaluate the safety and efficacy of adjunctive catheter-directed thrombolysis (CDT) during primary percutaneous coronary intervention (PCI) for STEMI patients with high thrombus burden.
  • To assess CDT's role as a potential treatment escalation.

Main Methods:

  • A retrospective analysis of 1849 STEMI patients, identifying 263 with high thrombus burden.
  • Comparison of outcomes between 41 patients receiving adjunctive CDT (intracoronary tissue plasminogen activator) and 222 patients not receiving CDT during primary PCI.
  • Assessment of bleeding complications, mortality, and coronary blood flow post-intervention.

Main Results:

  • No significant differences in bleeding complications or in-hospital/long-term mortality between CDT and non-CDT groups.
  • Lower initial post-thrombectomy coronary blood flow (Thrombolysis In Myocardial Infarction grade 2 or 3) in the CDT group (32.2%) compared to the non-CDT group (61.0%).
  • Final coronary blood flow rates were similar between groups (90.3% vs. 97.4%).

Conclusions:

  • Adjunctive CDT is well-tolerated and feasible in STEMI patients with high thrombus burden.
  • CDT may be a beneficial therapeutic option for patients experiencing failed aspiration thrombectomy during PCI.
Abstract

Keywords:
catheter-directed thrombolysishigh coronary thrombus burdentissue plasminogen activator

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