title: Impact of thrombus burden on procedural and mid-term outcomes after primary percutaneous coronary intervention.
abstract: 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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Interventional Cardiology Unit, Department of Cardiology, Ramón y Cajal Hospital, University of Alcalá, Madrid, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Martí
authors.forename: Luisa
authors.initials: L
authors.lastname: Salido
authors.forename: José L
authors.initials: JL
authors.lastname: Mestre
authors.forename: María J
authors.initials: MJ
authors.lastname: Esteban
authors.forename: Eduardo
authors.initials: E
authors.lastname: Casas
authors.forename: Manuel
authors.initials: M
authors.lastname: Jiménez-Mena
authors.forename: Jaime
authors.initials: J
authors.lastname: Pey
authors.forename: Marcelo
authors.initials: M
authors.lastname: Sanmartín
authors.forename: Rosana
authors.initials: R
authors.lastname: Hernández-Antolín
authors.forename: José L
authors.initials: JL
authors.lastname: Zamorano
mesh_terms: D000077284:Abciximab; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D000077284:Abciximab