Thromboelastography-based assessment of thrombus burden in ST-elevation myocardial infarction

BACKGROUND: Thromboelastography (TEG) offers real-time evaluation of hemostatic function and holds promise for assessing thrombus burden during ST-segment elevation myocardial infarction (STEMI). This study aimed to validate the diagnostic utility of kaolin-activated TEG in correlating coagulation parameters with angiographic thrombus burden in acute STEMI patients. METHODS: Eighty-one consecutive STEMI patients (age 18-75 years) underwent TEG testing during emergency visit just prior to primay percutaneous coronary intervention (PPCI). Diagnostic validity for TEG indices (R-time, K-time, α-angle, MA, CI, TPI, Ly30) was assessed by sensitivity, specificity, predictive values, and odds ratios. RESULTS: R-time and K-time showed high specificity (96.4% and 85.7%, respectively) and positive predictive values (85.7% and 75%), supporting their use as specific indicators ("SPIN") for thrombus presence. However, sensitivity of all indices was low (R: 12.5%, K: 27.3%), limiting their utility as screening tools. The α-angle and MA displayed moderate specificity (71.4% and 57.7%), with positive predictive values of 60% and 63.3% respectively. The α-angle significantly correlated with higher thrombus grades (p = 0.01), indicating faster fibrin polymerization in more severe cases. Gains in diagnostic knowledge were highest for R-min (23%) and K-min (14%). CONCLUSION: Kaolin-activated TEG, particularly R-time and K-time, demonstrates high specificity but limited sensitivity for identifying high thrombus burden during STEMI. The α-angle remains clinically informative for clot kinetics. While TEG may complement existing assessments for targeted antithrombotic therapy, its greatest utility lies in confirming, rather than screening for, severe thrombus burden. Further prospective studies are warranted to refine its prognostic value (Graphical abstract).