Key result
Residual thrombus volume ≥4.14 mm3 after STEMI thrombectomy is linked to ~195% higher MACE risk.
Why the study?
The prognostic significance of residual thrombus volume after aspiration thrombectomy in patients with STEMI remains unclear.
Does higher residual thrombus volume quantified by post-aspiration OCT predict major adverse cardiovascular events in patients with STEMI undergoing primary PCI?
Cohort (n=233)
No
Does higher residual thrombus volume quantified by post-aspiration OCT predict major adverse cardiovascular events in patients with STEMI undergoing primary PCI?
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Our study is now published in JACC: Asia! OCT-quantified residual thrombus after aspiration thrombectomy independently predicted cardiovascular events in STEMI.”
Higher residual thrombus volume quantified by OCT after aspiration thrombectomy in STEMI patients is independently associated with an increased risk of major adverse cardiovascular events.
BACKGROUND The prognostic significance of residual thrombus volume after aspiration thrombectomy in patients with ST-segment elevation myocardial infarction (STEMI) remains unclear. OBJECTIVES The authors aimed to investigate whether residual thrombus volume quantified by post-aspiration optical coherence tomography (OCT) is associated with major adverse cardiovascular events (MACE) in patients with STEMI undergoing primary percutaneous coronary intervention (PCI). METHODS This retrospective single-center study included 233 patients with STEMI who underwent manual aspiration thrombectomy followed by OCT-guided primary PCI within 12 hours of symptom onset. Residual thrombus volume was quantified at 1.0-mm intervals. The optimal cutoff was determined using maximally selected log-rank statistics. The primary endpoint was MACE, defined as cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Associations with MACE were evaluated using Kaplan-Meier and Cox regression analyses. RESULTS During a median follow-up of 2.5 years (IQR: 1.3-3.5 years), MACE occurred in 46 patients (19.7%). Patients with residual thrombus volume ≥4.14 mm3 had a higher cumulative incidence of MACE than those with <4.14 mm3 (log-rank P = 0.0018). Residual thrombus volume remained independently associated with MACE as a continuous variable (adjusted HR: 1.014 per 1 mm3 increase; 95% CI: 1.001-1.027; P = 0.031). Similar findings were observed using the 4.14-mm3 cutoff (adjusted HR: 2.95; 95% CI: 1.51-5.74; P = 0.002). CONCLUSIONS Residual thrombus burden quantified by OCT after aspiration thrombectomy was independently associated with adverse cardiovascular outcomes in patients with STEMI. Quantitative OCT assessment may provide complementary prognostic information for post-PCI risk stratification.
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Endo et al. (2026) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=233). Residual thrombus volume ≥4.14 mm3 vs. Residual thrombus volume <4.14 mm3 was evaluated on MACE, defined as cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure (adjusted HR 2.95, 95% CI 1.51-5.74, p=0.002). Residual thrombus volume ≥4.14 mm3 after aspiration thrombectomy in STEMI was associated with a significantly higher risk of MACE (adjusted HR 2.95; 95% CI 1.51-5.74; P=0.002).
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