The Thrombus We Leave Behind

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: ST-segment elevation myocardial infarction (STEMI) (n=233). Intervention: Residual thrombus volume ≥ 4.14 mm³ vs. Residual thrombus volume < 4.14 mm³. Primary outcome: Composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure (HR 2.95, 95% CI 1.51-5.74, p=0.002).

Bahjat Ghazzal; Ziyad B. Ghazzal

doi:10.1016/j.jacasi.2026.08.012

September 16, 2026JACC AsiaOpen Access

The Thrombus We Leave Behind

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Graphical abstract published by JACC Asia — Graphical abstract · Published by JACC Asia · CC BY-NC-ND

Why the study?

Does high residual thrombus volume measured by OCT after aspiration thrombectomy predict major adverse cardiovascular events in patients with STEMI?

Study Design

Type

Cohort (n=233)

Multicenter

No

Structured PICO

Does high residual thrombus volume measured by OCT after aspiration thrombectomy predict major adverse cardiovascular events in patients with STEMI?

P

Population

233 patients with STEMI treated within 12 hours of symptom onset who underwent manual aspiration thrombectomy followed by OCT imaging, assessed over a median follow-up of 2.5 years.

E

Exposure

High residual thrombus volume (≥4.14 mm³) as quantified by OCT

C

Comparator

Low residual thrombus volume (<4.14 mm³) as quantified by OCT

O

Outcome

Composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failurecomposite

Main Result

Hazard Ratio: 2.95 (95% CI 1.51–5.74)

Absolute Event Rate: 32.9% vs 13.8%

p-value: p=0.002

Limitations

Retrospective, single-center design introduces potential selection bias
The 4.14 mm³ residual thrombus cutoff was derived mathematically from a relatively small cohort, making it exploratory
Adding residual thrombus volume to established clinical risk factors yielded only minimal improvement in overall prognostic discrimination
Lack of information on how patients were managed after OCT
Cutoff of 4.14 mm³ was derived mathematically from a relatively small cohort (N=233), making it exploratory
Adding residual thrombus volume to established clinical risk factors yielded only minimal improvement in prognostic discrimination (C-index: 0.728-0.731)
Uncertainty regarding how patients were managed after OCT (e.g., adjunctive pharmacotherapies or additional aspiration)
Cannot determine whether residual thrombus is a causal mediator of adverse events or merely a marker of more severe thrombotic biology

Implication

Quantifying residual thrombus volume using OCT after aspiration thrombectomy provides an independent prognostic signal for major adverse cardiovascular events in STEMI patients.

Abstract

[Figure: see text]

Discussion

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Cite This Study

Ghazzal 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 Composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure (HR 2.95, 95% CI 1.51-5.74, p=0.002).

synapsesocial.com/papers/6ad1157300741cc3fba7d40f https://doi.org/10.1016/j.jacasi.2026.08.012

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The Thrombus We Leave Behind

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

The Thrombus We Leave Behind

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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