Determinants of Angiographic Thrombus Burden in Patients With ST-Segment Elevation Myocardial Infarction

Tanboğa, İbrahi̇m Hali̇l; Topçu, Selim; Aksakal, Enbiya; Kalkan, Kamuran; Sevimli, Serdar; Açıkel, Mahmut

doi:10.1177/1076029613483169

Cited by 60 publications

(52 citation statements)

References 21 publications

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“…Previous studies have demonstrated that age, diabetes mellitus, red cell distribution, intrinsic platelet reactivity, increased mean platelet volume at admission, increased epicardial adipose tissue thickness, bilirubin Levels, monocyte to HDL cholesterol ratio, SYNTAX score and absence of pre‐infarction angina were independent predictors of TB in patients with STEMI . In this cohort, we did not observe an association between the above mentioned predictors and intracoronary TB in these young adults with STEMI.…”

Section: Discussioncontrasting

confidence: 73%

“…Previous studies showed that the extent of coronary TB in patients with STEMI was associated with age, diabetes mellitus, red cell distribution, intrinsic platelet reactivity, higher troponin and leukocyte concentrations, increased mean platelet volume, increased epicardial adipose tissue thickness, bilirubin levels, monocyte to high‐density lipoprotein (HDL) cholesterol ratio and absence of pre‐infarction angina . It is to note that the study cohorts of above mentioned observations refereed mostly patient population aged >45‐years old.…”

Section: Introductionmentioning

confidence: 99%

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Determinants of angiographic thrombus burden and impact of thrombus aspiration on outcome in young patients with ST‐segment elevation myocardial infarction

Dong

et al. 2018

Cathet Cardio Intervent

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Objectives We aimed to investigate the determinants of thrombus burden (TB) and the impact of thrombus aspiration (TA) on outcome in young adults with ST segment elevation myocardial infarction (STEMI). Background The determinants of TB in young STEMI patients are not fully understood now. Methods The 182 young (age ≤ 45 years) STEMI patients, who underwent coronary angiography and percutaneous coronary intervention (PCI) in our hospital from January 2013 to September 2016, were included. Angiographic TB and impact of TA on major adverse cardiac events (MACEs) were evaluated. Median clinical follow‐up period was 875 (641–1,052) days. Results All patients were male, mean age was 40 ± 5 years. High thrombus burden (HTB) was evidenced in 100 (54.9%) patients. TA was performed in 62 out 100 (62%) patients with high TB (HTB) during PCI. The prevalence of hypertension was significantly higher in the HTB group than in the low thrombus burden (LTB) group (75 vs. 17%, P < 0.001). The proportion of smoking, alcohol consumption, and family history of premature coronary artery disease were similar between HTB and LTB groups. During follow‐up, 2 patients died and 31 patients underwent repeat PCI. MACE rate was significantly higher in the HTB group than in the LTB group (24.0 vs. 9.8%, P = 0.012) and significantly lower in HTB patients with TA than HTB patients without TA (14.5 vs. 39.5%, P = 0.018). Conclusions Hypertension is an independent determinant of HTB and TA could be considered as an effective therapeutic option in young male STEMI patients with HTB.

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Section: Discussioncontrasting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Determinants of angiographic thrombus burden and impact of thrombus aspiration on outcome in young patients with ST‐segment elevation myocardial infarction

Dong

et al. 2018

Cathet Cardio Intervent

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“…Angiographic coronary thrombus burden was scored based on TIMI thrombus grade. Patients with a thrombus burden of grade 4 or 5 were defined as having high thrombus burden, ad patients with thrombus burden < grade 4 was defined as having low thrombus burden (11). No thrombolytic therapy or thrombectomy was administered before or after the procedures.…”

Section: Methodsmentioning

confidence: 99%

The effects of tirofiban infusion on clinical and angiographic outcomes of patients with STEMI undergoing primary PCI

Kaymaz¹,

Keleş²,

Özdemir³

et al. 2015

Anatol J Cardiol

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Objective:The present study was designed to determine the effects of tirofiban (Tiro) infusion on angiographic measures, ST-segment resolution, and clinical outcomes in patients with STEMI undergoing PCI. Glycoprotein (GP) IIb/IIIa inhibitors are beneficial in ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI), while the most effective timing of administration is still under investigation.Methods:A total of 1242 patients (83.0% males, mean (standard deviation; SD) age: 54.7 (10.9) years) with STEMI who underwent primary PCI were included in this retrospective non-randomized study in four groups, composed of no tirofiban infusion [Tiro (-); n=248], tirofiban infusion before PCI (pre-Tiro; n=720), tirofiban infusion during PCI (peri-Tiro; n=50), and tirofiban infusion after PCI (post-Tiro; n=224). In all Tiro (+) patients, bolus administration of Tiro (10 pg/kg) was followed by infusion (0.15 pg/kg/min) for a mean (SD) duration of 22.4±6.8 hours.Results:The pre-PCI Tiro group was associated with the highest percentage of patients with TIMI 3 flow (99.4%; p<0.001), the lowest corrected TIMI frame count [21(18-23.4); p<0.001], the highest percentage of patients with >75% ST-segment resolution (78.1%; p<0.001), and the lowest rate of in-hospital sudden cardiac death and in-hospital all-cause mortality (3.2%, p<0.05, 3.3%, p=0.01). Major bleeding was reported in 18 (1.8%) patients who received tirofiban.Conclusion:Use of standard-dose bolus tirofiban in addition to aspirin, high-dose clopidogrel, and unfractionated heparin prior to primary PCI significantly improves myocardial reperfusion, ST-segment resolution, in-hospital mortality rate, and in-hospital sudden cardiac death in patients with STEMI with no increased risk of major bleeding.

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“…Prediction of thrombus burden and composition, as well as plaque volume and composition, before the procedure in patients with STEMI undergoing PPCI, may contribute to optimize percutaneous treatment of these highly thrombotic lesions, guiding utilization of pharmacological agents or interventional strategies, in order to reduce thrombus burden and improve both epicardial and myocardial perfusion. Grade Ⅲ ischemia on electrocardiogram, defined as distortion of the terminal portion of the QRS complex, and red cell distribution width (RDW), a marker of variation in the size of circulating red cells routinely reported as a part of blood count analysis, were shown to be independent predictors of coronary thrombus burden in STEMI patients undergoing PPCI, and to be associated with angiographic no-reflow and impaired epicardial and myocardial perfusion [39][40][41] . Probably, also the evaluation of thrombus burden using, not only coronary angiography, but also intravascular imaging modalities, such as ultrasound, optical coherence tomography or virtual histology, may provide important informations about the amount and composition of coronary thrombi, thus facilitating the choice of treatment strategies.…”

Section: Prognostic Significance Of Angiographically Detected Coronarmentioning

confidence: 99%

Coronary thrombus in patients undergoing primary PCI for STEMI: Prognostic significance and management

Vecchio¹

2014

WJC

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Acute ST-elevation myocardial infarction (STEMI) usually results from coronary atherosclerotic plaque disruption with superimposed thrombus formation. Detection of coronary thrombi is a poor prognostic indicator, which is mostly proportional to their size and composition. Particularly, intracoronary thrombi impair both epicardial blood flow and myocardial perfusion, by occluding major coronary arteries and causing distal embolization, respectively. Thus, although primary percutaneous coronary intervention is the preferred treatement strategy in STEMI setting, the associated use of adjunctive antithrombotic drugs and/or percutaneous thrombectomy is crucial to optimize therapy of STEMI patients, by improving either angiographical and clinical outcomes. This review article will focus on the prognostic significance of intracoronary thrombi and on current antithrombotic pharmacological and interventional strategies used in the setting of STEMI to manage thrombotic lesions.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words: ST-elevation myocardial infarction; Intracoronary thrombosis; Primary percutaneous coronary intervention; Antithrombotic therapies; Coronary thrombectomyCore tip: Intracoronary thrombosis, is the basic pathophysiologic event in acute ST-elevation myocardial infarction (STEMI), and thrombi are very frequently detected in STEMI patients undergoing primary percutaneous coronary intervention (PPCI). Thrombus burden and components are important determinants of prognosis in STEMI, being well-known risk factors for longterm adverse cardiovascular events, distal embolization and stent thrombosis. As a result, percutaneous management of lesions with a consistent thrombotic burden is still challenging in the setting of PPCI for STEMI. Therefore, several pharmacological and interventional strategies, such as thrombectomy have been developed in order to improve PPCI's safety and efficacy, by reducing thrombus burden.

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Determinants of Angiographic Thrombus Burden in Patients With ST-Segment Elevation Myocardial Infarction

Cited by 60 publications

References 21 publications

Determinants of angiographic thrombus burden and impact of thrombus aspiration on outcome in young patients with ST‐segment elevation myocardial infarction

Determinants of angiographic thrombus burden and impact of thrombus aspiration on outcome in young patients with ST‐segment elevation myocardial infarction

The effects of tirofiban infusion on clinical and angiographic outcomes of patients with STEMI undergoing primary PCI

Coronary thrombus in patients undergoing primary PCI for STEMI: Prognostic significance and management

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