Large angiographic thrombus burden in STEMI patients undergoing primary PCI did not significantly affect the composite of death, reinfarction, or target vessel revascularization (HR 0.88; 95% CI 0.46-1.67; P=0.691).
Cohort (n=480)
Does large thrombus burden worsen the composite of death, reinfarction, or target vessel revascularization in STEMI patients undergoing primary percutaneous coronary intervention?
In STEMI patients undergoing primary PCI, large thrombus burden is associated with larger infarct size and more angiographic complications, but does not significantly worsen mid-term clinical outcomes.
Effect estimate: HR 0.88 (95% CI 0.46-1.67)
Absolute Event Rate: 12.8% vs 16.2%
p-value: p=0.691
OBJECTIVE: Angiographic thrombus burden (TB) can be assessed early and enable a decision on intervention. The aim of this study was to analyze its effect on the incidence of cardiac events after a primary percutaneous coronary intervention. PATIENTS AND METHODS: We carried out a prospective study of 480 consecutive ST-segment elevation myocardial infarction patients treated by systematic primary percutaneous coronary intervention. Large TB was defined as thrombus length at least 2 vessel diameters or as solid thrombus obtained through catheter aspiration. The primary outcome measure was a composite of death, reinfarction, or target vessel revascularization. RESULTS: A total of 205 (47%) patients fulfilled the criteria for large TB. These patients were more frequently treated with abciximab (62.0 vs. 35.8%, P<0.001), showed more angiographic complications (26.6 vs. 13.7%, P=0.001), and had larger infarcts (peak troponin I, 74 vs. 50 ng/ml, P=0.015). During a follow-up of 19 ± 5 months, the rates of primary outcome were similar between groups of small and large TB (16.2 vs. 12.8%, hazard ratio: 0.88, 95% confidence interval: 0.46-1.67, P=0.691). There were no differences in the rates of definite stent thrombosis (0.5 vs. 2.2%, P=0.190). CONCLUSION: Large TB is associated with larger infarct size, but not with worse mid-term outcomes. Selective use of adjuvant therapies according to TB may be an effective approach to reduce thrombotic complications.
Sánchez et al. (Thu,) conducted a cohort in ST-segment elevation myocardial infarction (n=480). Large thrombus burden vs. Small thrombus burden was evaluated on composite of death, reinfarction, or target vessel revascularization (HR 0.88, 95% CI 0.46-1.67, p=0.691). Large angiographic thrombus burden in STEMI patients undergoing primary PCI did not significantly affect the composite of death, reinfarction, or target vessel revascularization (HR 0.88; 95% CI 0.46-1.67; P=0.691).
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