Sung Gyun Ahn1, Hyun-Hee Choi, Ji Hyun Lee, Jun-Won Lee, Young Jin Youn, Sang-Yong Yoo, Byung Ryul Cho, Seung-Hwan Lee, Junghan Yoon. 1. aDivision of Cardiology, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju bDivision of Cardiology, Hallym University Chuncheon Sacred Heart Hospital cDepartment of Internal Medicine, Division of Cardiology, Kangwon National University College of Medicine, Kangwon National University Hospital, Chuncheon dDivision of Cardiology, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, Republic of Korea.
Abstract
BACKGROUND: Limited data are available on the clinical significance of residual thrombi after thrombectomy and prestenting reduced epicardial coronary flow in ST-segment elevation myocardial infarct (STEMI) patients. MATERIALS AND METHODS: The incidence of the no-reflow phenomenon, defined as a final thrombolysis in myocardial infarction (TIMI) flow grade of up to 2 or a myocardial blush grade of up to 1, was compared in 260 STEMI patients undergoing primary percutaneous coronary intervention according to thrombotic burden. Large thrombotic burden (LTB), defined as a thrombus score of at least 3, was observed in 134 patients, among whom 66 (49.3%) underwent aspiration thrombectomy. No-reflow incidence was compared on the basis of thrombectomy treatment, thrombus residue after thrombectomy, and prestenting TIMI flow grade. RESULTS: The no-reflow phenomenon occurred most frequently in LTB patients without thrombectomy, followed by those who underwent thrombectomy and the small thrombus burden group (33.8 vs. 21.2 vs. 10.3%, respectively, P<0.001). Patients with a prestenting residual thrombus or a TIMI flow grade of up to 2 had higher no-reflow incidence than those with no visible prestenting thrombus and a TIMI flow grade of 3 (74 vs. 6.2%, P<0.001). Multiple logistic regression analysis identified a prestenting TIMI flow grade of up to 2 (odds ratio 36.422, 95% confidence interval 13.952-95.079) as an independent predictor of the no-reflow phenomenon. CONCLUSION: Manual thrombus aspiration reduced no-reflow incidence in STEMI patients with LTB. However, even after thrombectomy, prestenting residual thrombi and decreased coronary flow were related to a higher occurrence of the no-reflow phenomenon.
BACKGROUND: Limited data are available on the clinical significance of residual thrombi after thrombectomy and prestenting reduced epicardial coronary flow in ST-segment elevation myocardial infarct (STEMI) patients. MATERIALS AND METHODS: The incidence of the no-reflow phenomenon, defined as a final thrombolysis in myocardial infarction (TIMI) flow grade of up to 2 or a myocardial blush grade of up to 1, was compared in 260 STEMI patients undergoing primary percutaneous coronary intervention according to thrombotic burden. Large thrombotic burden (LTB), defined as a thrombus score of at least 3, was observed in 134 patients, among whom 66 (49.3%) underwent aspiration thrombectomy. No-reflow incidence was compared on the basis of thrombectomy treatment, thrombus residue after thrombectomy, and prestenting TIMI flow grade. RESULTS: The no-reflow phenomenon occurred most frequently in LTB patients without thrombectomy, followed by those who underwent thrombectomy and the small thrombus burden group (33.8 vs. 21.2 vs. 10.3%, respectively, P<0.001). Patients with a prestenting residual thrombus or a TIMI flow grade of up to 2 had higher no-reflow incidence than those with no visible prestenting thrombus and a TIMI flow grade of 3 (74 vs. 6.2%, P<0.001). Multiple logistic regression analysis identified a prestenting TIMI flow grade of up to 2 (odds ratio 36.422, 95% confidence interval 13.952-95.079) as an independent predictor of the no-reflow phenomenon. CONCLUSION: Manual thrombus aspiration reduced no-reflow incidence in STEMI patients with LTB. However, even after thrombectomy, prestenting residual thrombi and decreased coronary flow were related to a higher occurrence of the no-reflow phenomenon.