title: Does Residual Thrombus After Aspiration Thrombectomy Affect the Outcome of Primary PCI in Patients With ST-Segment Elevation Myocardial Infarction?: An Optical Coherence Tomography Study.
abstract: The aim of this study was to evaluate if residual thrombus burden after aspiration thrombectomy affects the outcomes of primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction (STEMI).
  
  
  
  Recent studies failed to show clinical benefit of aspiration thrombectomy in STEMI patients. This might be due to insufficient removal of thrombus at the culprit lesion.
  
  
  
  A total of 109 STEMI patients who underwent aspiration thrombectomy followed by stenting within 24 h from symptom onset were included. Optical coherence tomography was performed after thrombectomy to measure residual thrombus burden. Patients were divided into tertiles based on the amount of residual thrombus and the outcomes were compared.
  
  
  
  Myocardial no reflow, defined as TIMI (Thrombolysis In Myocardial Infarction) flow grade of ≤2 and/or myocardial blush grade of ≤1 after stenting, was more observed frequently in patients in the highest tertile compared with those in the lowest tertile (44.4% vs. 16.7%; p = 0.001). Patients in the highest tertile also had greater myocardial damage measured by creatine kinase MB compared with those in the lowest tertile (p = 0.002).
  
  
  
  STEMI patients with greater residual thrombus burden after aspiration thrombectomy had worse microvascular dysfunction and greater myocardial damage compared with those with smaller residual thrombus burden.
authors.affiliation: Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Takumi
authors.initials: T
authors.lastname: Higuma
authors.affiliation: Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Tsunenari
authors.initials: T
authors.lastname: Soeda
authors.affiliation: Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yamada
authors.affiliation: Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yokota
authors.affiliation: Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Yokoyama
authors.affiliation: Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Izumiyama
authors.affiliation: Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Fumie
authors.initials: F
authors.lastname: Nishizaki
authors.affiliation: Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Minami
authors.affiliation: Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Lei
authors.initials: L
authors.lastname: Xing
authors.affiliation: Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Erika
authors.initials: E
authors.lastname: Yamamoto
authors.affiliation: Biostatistics Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Hang
authors.initials: H
authors.lastname: Lee
authors.affiliation: Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Okumura
authors.affiliation: Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Division of Cardiology, Kyung Hee University, Seoul, Republic of Korea. Electronic address: ijang@mgh.harvard.edu.
authors.forename: Ik-Kyung
authors.initials: IK
authors.lastname: Jang
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D003326:Coronary Circulation; D003328:Coronary Thrombosis / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology; D052279:Creatine Kinase, MB Form / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism / Q000473:pathology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D015607:Stents; D013396:Suction; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D052279:Creatine Kinase, MB Form
keywords: ST-segment elevation myocardial infarction; intracoronary thrombus; optical coherence tomography; percutaneous coronary intervention