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A study of intracoronary thrombolytic agents in high thrombus burden lesions during primary PCI
Venkata Rs Subrahmanya Sarma1, K Gopalakrishna1, K Purnachandra Rao1
1Cardiology Department, Aayush Hospitals, Vijayawada, Andhra Pradesh, India.
Insights
Intracoronary thrombolysis in high thrombus burden patients undergoing primary percutaneous coronary intervention showed similar primary outcomes to stenting alone. However, event rates consistently rose in the stenting group over one year.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- High thrombus burden in primary percutaneous coronary intervention is linked to adverse patient outcomes.
- Current management strategies for these patients have limitations.
Purpose of the Study:
- To evaluate the long-term results of primary percutaneous coronary intervention in patients with high thrombus burden.
- To assess the effectiveness of intracoronary thrombolysis as an adjunctive therapy.
Main Methods:
- A prospective observational study included 108 patients with high thrombus burden undergoing primary percutaneous coronary intervention.
- Patients were divided into two groups: primary stenting versus primary stenting with adjunctive intracoronary thrombolysis.
- Primary endpoint was Net Adverse Clinical Events; secondary endpoints included Major Adverse Cardiac Events.
Main Results:
- The primary outcome occurred in 26% of the primary stent group (n=80) versus 6% in the intracoronary thrombolysis group (n=28).
- No statistically significant difference was found in primary endpoints between the groups (p=0.042).
- Kaplan-Meier curves indicated separated event-free survival curves at one year, with a consistent increase in events in the primary stent group.
Conclusions:
- No significant difference in primary outcomes was observed between the two treatment strategies.
- A trend towards increased adverse events was noted in the primary stent group over the one-year follow-up.
- Larger randomized clinical trials are warranted to validate these findings and clarify treatment efficacy.
Objectives:
High thrombus burden during Primary Percutaneous Coronary Intervention begets poor outcomes; there are several lacunas in the management of those patients.- The purpose of this study is to analyse the long-term outcomes of patients undergoing primary percutaneous coronary intervention with high thrombus burden, treated with intracoronary thrombolysis as an adjunctive therapy.
Methods:
In this prospective observational study, 108 consecutive primary percutaneous coronary intervention patients with high thrombus burden were stratified into two groups basing on whether they received intracoronary thrombolytic agent before stent implantation. The primary outcome is Net Adverse Clinical Events. Secondary outcomes include Major Adverse Cardiac Events, and all other individual components of the Net Adverse Clinical Events when analysed separately.
Results:
The primary outcome events occurred in 21 patients (26 %) in the Primary stent group (n = 80), whereas it occurred in 2 patients (6 %) in the primary intra-coronary thrombolysis group (n = 28), this study shows that there is no difference in primary endpoints in both groups (26 % Vs 7 %, p-value - .042, Hazard ratio - 2.56; 95 % CI - .76-8.57), however Kaplan-Meier event-free survival curves show that both the curves are well separated apart even at the end of the one year of follow - up.
Conclusion:
There is no difference in the primary outcome events in both groups, however there was a consistent increase in events in the primary stent group over the one-year follow-up period. These findings suggest the need for a larger randomized clinical trial to confirm and further elucidate these results.
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