Angiographic quantification of thrombus in ST-elevation acute myocardial infarction presenting with an occluded infarct-related artery and its relationship with results of percutaneous intervention.
BACKGROUND
Routine thrombectomy has been advocated for ST-segment-elevation myocardial infarction (STEMI), but it is unknown how many patients present with a large thrombus. We aimed to quantify the intracoronary thrombus in STEMI and to correlate it with procedure results.


METHODS
In 98 patients with STEMI and TIMI flow grades 0-2 in the infarct-related artery, thrombus was qualified as small (ST) when its maximal dimension was <2 vessel diameters and large (LT) when >or=2. Main outcome measures were TIMI flow, myocardial blush grade (MBG), corrected TIMI frame count (cTFC), and ST-segment elevation resolution (STSER).


RESULTS
Only a third of the patients presented with an LT. Thrombus grade was independent of the initial vessel patency. Diabetes (OR 3.1, 95% CI 1.20-8.02, P = 0.027) and pretreatment with clopidogrel (OR 0.27, 95% CI 0.08-0.86, P = 0.034) were independent predictors of LT. LT was an independent predictor of unfavorable results: <3 TIMI flow (OR 2.87, 95% CI 1.04-8.00, P = 0.043), MBG 0-1 (OR 3.36, 95% CI 1.10-10.26, P = 0.033), cTFC > 21 (OR 2.86, 95% CI 1.09-7.49, P = 0.033) and <50% STSER (OR 3.19, 95% CI 1.06-9.63, P = 0.039).


CONCLUSIONS
Only a third of STEMI patients present with an LT, being diabetes and lack of clopidogrel pretreatment independent predictors. An LT is strongly associated with worse PCI results.
Miranda-Guardiola
Faustino
F
Hospital del Mar, Barcelona, Spain. 93144@imas.imim.es
Rossi
Angelica
A
Serra
Antonio
A
Garcia
Bruno
B
Rumoroso
José Ramón
JR
Iñiguez
Andrés
A
Vaquerizo
Beatriz
B
Triano
José Luis
JL
Sierra
Gilberto
G
Bruguera
Jordi
J
D015906:Angioplasty, Balloon, Coronary; D015331:Cohort Studies; D016001:Confidence Intervals; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome