Key result
Adjunctive catheter-directed thrombolysis during primary PCI for STEMI with high thrombus burden showed no significant difference in long-term mortality compared to no CDT (12.6% vs 17.5%, p=0.84).
Why the study?
High coronary thrombus burden is associated with unfavorable outcomes in STEMI patients, and its optimal management has not yet been established.
Does adjunctive catheter-directed thrombolysis improve outcomes or coronary flow in patients with STEMI and high thrombus burden undergoing primary PCI?
Cohort (n=263)
Does adjunctive catheter-directed thrombolysis improve outcomes or coronary flow in patients with STEMI and high thrombus burden undergoing primary PCI?
Absolute Event Rate: 12.6% vs 17.5%
p-value: p=0.84
Adjunctive catheter-directed thrombolysis during primary PCI for STEMI with high thrombus burden appears feasible and safe, particularly as an option after failed aspiration thrombectomy, without significantly increasing bleeding or mortality.
Supports feasibility of adjunctive CDT after failed thrombectomy in high-thrombus STEMI; leaves open need for randomized efficacy trials.
Background: High coronary thrombus burden has been associated with unfavorable outcomes in patients with ST-segment elevation myocardial infarction (STEMI), the optimal management of which has not yet been established. Methods: We assessed the adjunctive catheter-directed thrombolysis (CDT) during primary percutaneous coronary intervention (PCI) in patients with STEMI and high thrombus burden. CDT was defined as intracoronary infusion of tissue plasminogen activator (t-PA; monteplase). Results: Among the 1849 consecutive patients with STEMI, 263 had high thrombus burden. Moreover, 41 patients received t-PA (CDT group), whereas 222 did not receive it (non-CDT group). No significant differences in bleeding complications and in-hospital and long-term mortalities were observed (9.8% vs. 7.2%, p = 0.53; 7.3% vs. 2.3%, p = 0.11; and 12.6% vs. 17.5%, p = 0.84, CDT vs. non-CDT). In patients who underwent antecedent aspiration thrombectomy during PCI (75.6% CDT group and 87.4% non-CDT group), thrombolysis in myocardial infarction grade 2 or 3 flow rate after thrombectomy was significantly lower in the CDT group than in the non-CDT group (32.2% vs. 61.0%, p < 0.01). However, the final rates improved without significant difference (90.3% vs. 97.4%, p = 0.14). Conclusions: Adjunctive CDT appears to be tolerated and feasible for high thrombus burden. Particularly, it may be an option in cases with failed aspiration thrombectomy.
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Noma et al. (2022) conducted a cohort in ST-Segment Elevation Myocardial Infarction with High Thrombus Burden (n=263). Adjunctive catheter-directed thrombolysis (t-PA) vs. No catheter-directed thrombolysis was evaluated on Long-term mortality (p=0.84). Adjunctive catheter-directed thrombolysis during primary PCI for STEMI with high thrombus burden showed no significant difference in long-term mortality compared to no CDT (12.6% vs 17.5%, p=0.84).
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