Takumi Higuma1, Tsunenari Soeda2, Masahiro Yamada3, Takashi Yokota3, Hiroaki Yokoyama3, Kei Izumiyama3, Fumie Nishizaki3, Yoshiyasu Minami2, Lei Xing2, Erika Yamamoto2, Hang Lee4, Ken Okumura3, Ik-Kyung Jang5. 1. Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. 2. Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. 3. Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan. 4. Biostatistics Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. 5. 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.
Abstract
OBJECTIVES: 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). BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
OBJECTIVES: 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). BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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: Johannes Blumenstein; Steffen Daniel Kriechbaum; Jürgen Leick; Alexander Meyer; Won-Keun Kim; Jan Sebastian Wolter; Maisun Abu-Samra; Kay Weipert; Matthias Bayer; Oliver Dörr; Claudia Walther; Christian W Hamm; Holger Nef; Christoph Liebetrau; Helge Möllmann Journal: J Thromb Thrombolysis Date: 2018-02 Impact factor: 2.300
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