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

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• 作者：Takumi Higuma ; MD ; PhD^a ; ^b ; Tsunenari Soeda ; MD ; PhD^b ; Masahiro Yamada ; MD ; PhD^a ; Takashi Yokota ; MD ; PhD^a ; Hiroaki Yokoyama ; MD ; PhD^a ; Kei Izumiyama ; MD ; PhD^a ; Fumie Nishizaki ; MD ; PhD^a ; Yoshiyasu Minami ; MD ; PhD^b ; Lei Xing ; MD ; PhD^b ; Erika Yamamoto ; MD ; PhD^b ; Hang Lee ; PhD^c ; Ken Okumura ; MD ; PhD^a ; Ik-Kyung Jang ; MD ; PhD^b ; ^d ; ^{ijang@mgh.harvard.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：intracoronary thrombus ; optical coherence tomography ; percutaneous coronary intervention ; ST-segment elevation myocardial infarction
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2016
• 出版时间：10 October 2016
• 年：2016
• 卷：9
• 期：19
• 页码：2002-2011
• 全文大小：851 K

文摘

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.