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

Abstract

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.

Acute Myocardial Infarction in Young Adults: Prevalence, Clinical Background and In-Hospital Outcomes with Particular Reference to Socio-Economic Influences a Middle Eastern Tertiary Center Experience

“…Similar to our finding, a study done during 2016 showed that the top three significant positive correlated variables for longer LOS were patients with heart failure, who were older and female [32]. It was consistent with the findings about factors related to prolonged LOS from literature: female, increasing age, and comorbidities such as cerebrovascular disease and diabetes mellitus [33,36].…”

Comparison of the Characteristics, Management, and Outcomes of STEMI Patients Presenting With vs. Those of Patients Presenting Without COVID-19 Infection: A Systematic Review and Meta-Analysis

“…In addition, our study found that the time from SO-to-FMC and D2B was longer in STEMI patients with COVID-19 than in those without COVID-19. The studies of Duman et al ( 44 ) and Ge et al ( 45 ) reported that the delay in SO-to-FMC and D2B would prolong the time for opening infarct-related vessels which may account for a higher thrombus burden. Therefore, in the COVID era, it is of great significance that novel technologies should be developed so as to achieve more efficient thrombus aspiration in patients with very high intra-coronary thrombus burden such as patients with STEMI and coexistent COVID-19 infection ( 46 ).…”

Thrombus aspiration during primary percutaneous coronary intervention improved outcome in patients with STEMI and a large thrombus burden

“… 13 In addition, TA reduced the incidence of MACE by more than half, including cardiac mortality, recurrent MI, stroke, coronary artery bypass graft, and repeat PCI in STEMI adults with a high thrombus burden. 9 Recent prospective randomization clinical trials confirmed that TA improved myocardial perfusion but failed to improve the prognosis, possibly because of the short follow-up period. 8 While several studies indicated that TA during PPCI was not associated with a better clinical prognosis, 14 – 16 a meta-analysis reported that patients with a high thrombus burden received the highest potential benefit from TA.…”

“…Consistent with the hypothesis that patients with a higher thrombus burden may benefit from TA, recent studies showed that TA can better improve myocardial reperfusion in patients with STEMI and a high thrombus load and significantly decrease the cumulative major adverse cardiac events (MACE) rate of the 1-year outcome. 8 , 9 However, both the TASTE and TOTAL trials did not show a benefit in the primary outcome for patients with a high thrombus burden. 6 , 7 To date, the benefit of TA for patients with large thrombus burden remains controversial.…”