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Thrombus burden classification. RVD reference vessel diameter. The Thrombolysis In the Myocardial Infarction (TIMI) thrombus classification consists of six grades from grade 0 (no thrombus) to grade 5 (total occlusion). Grade 5 represents an occluded infarct related artery and prevents thrombus size assessment. Grade 5 was reclassified after guidewire crossing or small (diameter 1.5 mm) deflated balloon passage. After G5 reclassification, large thrombus burden (LTB) was defined as being greater than or equal to two vessel diameters or greater (G4) and small thrombus burden (STB) defined by thrombus grade < G4
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Large thrombus burden (LTB) during ST-segment elevation myocardial infarction (STEMI) could translate into worse clinical outcomes. The impact of a LTB in terms of long-term clinical outcomes on different myocardial infarct territories has not yet been fully evaluated. From April 2002 to December 2004, consecutive patients with STEMI undergoing per...
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Objectives
To determine the rate of functionally significant (fractional flow reserve, FFR ≤ 0.80) coronary bifurcation stenoses that are considered anatomically significant based on angiographic estimation and to define predictors of functional significance of stenoses in main vessel and side branch.
Background
To date, the rate of functionally s...
Citations
... The existence of residual thrombus and poor post-procedural TIMI flow did not differ between STEMI patients with and without SIH. The significance of the reported findings is highlighted by the fact that poor procedural TIMI flow during PPCI, LTB and distal embolization are all determinants of larger infract size, lower left ventricular ejection fraction and MACCE [34][35][36]. ...
Background
Stress induced hyperglycemia (SIH) is common among patients with ST-elevation myocardial infarction (STEMI), even in patients without diabetes mellitus. However, evidence regarding its role on the angiographic outcomes and the prognosis of patients presenting with STEMI is scarce.
Methods
This study included 309 consecutively enrolled STEMI patients undergoing primary percutaneous coronary intervention (pPCI). Patients were diagnosed with SIH if blood glucose on admission was > 140 mg/dl. Also, patients had to fast for at least 8 hours before blood sampling. The objective was to assess whether SIH was associated with major adverse cardiovascular and cerebrovascular (MACCE) events and explore its relationship with angiographic predictors of worse prognosis such as poor initial TIMI flow, intracoronary thrombus burden, distal embolization, and presence of residual thrombus after pPCI.
Results
SIH in diabetic and non-diabetic patients was associated with a higher incidence of LTB (aOR = 2.171, 95% CI 1.27–3.71), distal embolization (aOR = 2.71, 95% CI 1.51–4.86), and pre-procedural TIMI flow grade = 0 (aOR = 2.69, 95% CI 1.43–5.04) after adjusting for relevant clinical variables. Importantly, during a median follow-up of 1.7 years STEMI patients with SIH with or without diabetes experienced increased occurrence of MACCE both in univariate (HR = 1.92, 95% CI 1.19–3.01) and multivariate analysis (aHR = 1.802, 95% CI 1.01–3.21).
Conclusions
SIH in STEMI patients with or without diabetes was independently associated with increased MACCE. This could be attributed to the fact that SIH was strongly correlated with poor pre-procedural TIMI flow, LTB, and distal embolization. Large clinical trials need to validate SIH as an independent predictor of adverse angiographic and clinical outcomes to provide optimal individualized care for patients with STEMI.
Introduction:
This study investigates how non-O blood groups relate to thrombus burden (TB) and prognosis in STEMI patients, aiming to shed light on their association with thrombotic complications in cardiovascular diseases.
Methods:
Retrospectively, 1180 STEMI patients undergoing primary percutaneous coronary intervention were included. The study population was divided into groups according to TB status and the groups were compared in terms of basic clinical characteristics, laboratory parameters and ABO blood group types. In addition, short- (30 days) and long-term (12 months) clinical outcomes were assessed to evaluate the prognostic implications.
Results:
The analysis revealed a significant association between non-O blood groups and increased thrombus burden in STEMI patients (p = 0.001). Non-O blood group was independently associated with high thrombus burden (OR: 1.726, 95% CI: 1.279-2.330, p < 0.001). Additionally, patients with non-O blood groups had higher short and long-term mortality rates (HR: 2.480, 95% CI: 1.361-4.520, p = 0.003; HR: 2.347, 95% CI: 1.433-3.844, p = 0.001; respectively).
Conclusions:
This study emphasizes the significance of the ABO blood group system in STEMI outcomes, associating non-O blood groups with higher thrombus burden and poorer clinical outcomes. While proposing personalized treatment strategies based on blood group status to improve reperfusion interventions and outcomes, additional trials are needed to comprehensively evaluate their impact.
The blood glucose level at admission indicates (with some limitations) poor prognosis and thrombus burden in patients with the acute coronary syndrome (ACS). Our study aimed to measure the predictive value of the stress hyperglycemia ratio (SHR), an indicator of stress hyperglycemia, showing increased thrombus burden in patients with ACS. Patients (n = 1222) with ACS were enrolled in this cross-sectional study. Coronary thrombus burden was classified as high and low. SHR was calculated by dividing the admission serum glucose by the estimated average glucose derived from HbA1c. Low thrombus burden was detected in 771 patients, while high thrombus burden (HTB) was detected in 451 patients. SHR was found to be significantly higher in patients with HTB (1.1 ± .3 vs 1.06 ± .4; P = .002). SHR was determined as a predictor of HTB (odds ratio (OR) 1.547 95% CI (1.139-2.100), P < .001) as a result of univariate analysis. According to multivariate analysis, SHR was determined as an independent risk factor for HTB (OR 1.328 CI (1.082-1.752), P = .001). We found that SHR predicted thrombus burden with higher sensitivity than admission glucose level in patients with ACS.
TÓM TẮT Đặt vấn đề: Hút huyết khối thường quy trên bệnh nhân nhồi máu cơ tim cấp ST chênh lên không đem lại lợi ích trên lâm sàng. Tuy nhiên, kết cục của hút huyết khối trên phân nhóm bệnh nhân nhồi máu cơ tim ST chênh lên có gánh nặng huyết khối lớn vẫn chưa được tìm hiểu. Nghiên cứu này nhằm đánh giá kết cục nội viện của các bệnh nhân nhồi máu cơ tim ST chênh lên có gánh nặng huyết khối lớn được thực hiện hút huyết khối khi can thiệp mạch vành thì đầu. Phương pháp, đối tượng: Tiến cứu có can thiệp, các bệnh nhân nhồi máu cơ tim ST chênh lên có gánh nặng huyết khối lớn được hút huyết khối kết hợp can thiệp thì đầu Kết quả: 147 bệnh nhân nhồi máu cơ tim ST chênh lên có gánh nặng huyết khối lớn được chia thành nhóm hút huyết khối + can thiệp (n = 71) và nhóm can thiệp thường quy (n = 76). Tỷ lệ giảm chênh của đoạn ST và chỉ số tưới máu cơ tim TMP = 3 trong nhóm hút huyết khối cao hơn nhóm nhóm chứng có ý nghĩa thống kê. Tử vong nội viện trong nhóm hút huyết khối thấp hơn nhóm chứng có ý nghĩa thống kê (10,5% so với 1,4%; p = 0,034). Không có sự khác biệt về tỷ lệ đột quị giữa hai nhóm. Kết luận: Hút huyết khối trên bệnh nhân nhồi máu cơ tim ST chênh lên có gánh nặng huyết khối lớn giúp giảm nguy cơ tử vong nội viện và cải thiện sự giảm chênh của đoạn ST và chỉ số tưới máu cơ tim ABSTRACT USEFULNESS OF MANUAL THROMBUS ASPIRATION FOR PATIENTS UNDERGOING PRIMARY PCI FOR ACUTE STEMI WITH HIGH THROMBUS BURDEN Background: Routine thrombus aspiration during primary PCI does not improve clinical outcomes. However, the outcomes of manual thrombus aspiration for patients undergoing primary PCI for acute STEMI with high thrombus burden is still unclear. This studyevaluatedthe in - hospitaloutcomes of using manual thrombus aspiration in STEMI patients undergoingprimary PC Iand showing high thrombusburden. Method: An interventionprospective study was conducted on patients underwent primary pci for acute stemi with high thrombus burden. Result: 147 STEMI patients with high thrombus burden in coronary angiography divides into thrombus aspiration and PCI (n = 71) or conventional PCI (n = 76). The STsegment resolution and TIMI myocardial perfusion grading (TMP = 3) were significant higher in the aspiration + PCI group compared with the conventional PCI group. In - hospital mortality rate was lower in the aspiration + PCI group compared with the conventional PCI group (10,5% versus 1,4%; p = 0,034). There was no significant differences in the incidence of stroke between two group. Conclusions: Aspiration thrombectomy in STEMI patient with high thrombus burden improved in - hospital mortality, ST - segment resolution and TIMI myocardial perfusion grading.
