Key result
Patients with residual intrastent thrombus <16% after primary angioplasty showed significantly better final TIMI values (2.87 vs 2.67; P=0.014) and TIMI frame counts (11.71 vs 18.04; P=0.012).
Why the study?
Does high residual intrastent thrombus worsen angiographic indexes of myocardial reperfusion in STEMI patients undergoing primary angioplasty?
Observational (n=128)
Does high residual intrastent thrombus worsen angiographic indexes of myocardial reperfusion in STEMI patients undergoing primary angioplasty?
High residual intrastent thrombus after primary angioplasty in STEMI patients is associated with worse final microcirculatory angiographic indexes.
High residual intrastent thrombus was associated with impaired reperfusion; leaves open whether targeted reduction improves STEMI outcomes.
AIMS: Recent frequency-domain optical coherence tomography studies showed that a complete removal of thrombotic materials is rarely achieved after percutaneous coronary interventions for ST segment elevation myocardial infarction. Residual intrastent thrombus can embolize distally leading to microcirculatory injury. The aim was to find a possible correlation between residual intrastent thrombus and angiographic indexes of myocardial reperfusion. METHODS: The population consisted of 128 ST segment elevation myocardial infarction patients enrolled in the COCTAIL II trial. Intrastent thrombus at optical coherence tomography was defined as the maximum percentage value of thrombus area (thrombus area/stent area × 100 in the cross-section with largest thrombus). A thrombus area of at least 16% (mean value) was considered indicative of high residual intrastent thrombus. The following angiographic indexes of myocardial reperfusion were evaluated: thrombolysis in myocardial infarction (TIMI) value, corrected TIMI frame count and myocardial blush grade. RESULTS: Angiographic and optical coherence tomography results are available in 119 patients: 64 had a maximum percentage value of thrombus area less than 16%, whereas the remaining 55 had a residual intrastent thrombus at least 16%. No differences were found regarding the microcirculatory indexes at baseline angiogram. After intervention, patients with intrastent thrombus less than 16% showed a significant improvement in the final TIMI value (2.87 ± 0.33 vs 2.67 ± 0.54; P = 0.014), final TIMI frame count (11.71 ± 4.58 vs 18.04 ± 17.32; P = 0.012) and a nonsignificant improvement in the final myocardial blush grade value (2.58 ± 0.58 vs 2.43 ± 0.76; P = 0.255). CONCLUSION: Data obtained from this ancillary study of the COCTAIL II suggest that the presence of high residual intrastent thrombus in patients undergoing primary angioplasty is associated with worsened final microcirculatory indexes.
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Gatto et al. (2017) conducted an observational in ST segment elevation myocardial infarction (n=128). Low residual intrastent thrombus (<16%) vs. High residual intrastent thrombus (≥16%) was evaluated on Final TIMI value (p=0.014). Patients with residual intrastent thrombus <16% after primary angioplasty showed significantly better final TIMI values (2.87 vs 2.67; P=0.014) and TIMI frame counts (11.71 vs 18.04; P=0.012).
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