Quantification of Thrombus Burden as an Independent Predictor of Intra-Procedural No-Reflow in Patients With St-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Revascularization

Abstract

Background: Aim of this study was to perform quantitative evaluation of high thrombus burden (Grade ≥4) as an independent predictor of slow/no reflow phenomenon during primary percutaneous coronary interventions (PCI) of patients with ST-segment elevation myocardial infarction (STEMI). Methods: In this analytical cross-sectional study we included consecutive patients who have undergone primary PCI for STEMI at a tertiary care cardiac center of the Pakistan. High thrombus burden was defined as angiographic thrombus grade ≥ 4. The thrombolysis in myocardial infarction (TIMI) flow rate < III was defined as slow/no reflow phenomenon. Results of multivariate logistic regression analysis for slow/no reflow phenomenon were reported as odds ratio (OR). Results: This analysis included 747 patients, 78.2% (584) patients were male and mean age was 55.82±11.54 years. High thrombus burden was observed in 68.1% (509) of the patients. Slow/no reflow phenomenon was observed in 33.6% (251) which was more common among patients in high thrombus burden group, 39.7% (202/509) vs. 20.6% (49/238); p<0.001. Adjusted OR of thrombus Grade ≥ 4 was 2.33 [1.6 -3.39]; p<0.001. Other significant variables were female gender (1.51 [1.01 -2.27]; p=0.045), left ventricular end-diastolic pressure (LVEDP) ≥20 mmHg (2.34 [1.69 -3.26]; p<0.001), total lesion length ≥ 20 cm (1.54 [1.09-2.16]; p=0.014), and neutrophil count ≥ 8.8 cells/µL (1.72 [1.22 -2.43]; p=0.002). Conclusion: High thrombus burden (Grade ≥ 4) is a significant and an independent predictor of the slow/no reflow phenomenon. While predicting slow/no reflow phenomenon, thrombus burden should be given due importance along with other significant factors such as gender, LVEDP, lesion length, and neutrophil counts.

In-Hospital Outcomes of Manual Thrombus Aspiration Versus Pre-Balloon Dilatation During Primary Pci for Total Occlusion

“…1 High thrombus burden and plaque rupture, the two main pathogenesis, are associated with poor myocardial reperfusion with increased risk of slow/no-reflow during primary PCI. 2 Manual thrombus aspiration or pre-balloon dilatation after passing the coronary wire are the two widely adopted clinical approaches for primary PCI of patients with thrombolysis in myocardial infarction (TIMI) flow grade of 0. However, routine manual thrombus aspiration is downgraded from class IIa to class III in the current clinical practice guidelines.…”

Safety and efficacy of intracoronary recombinant human prourokinase administration in patients with acute myocardial infarction and ST‑segment elevation: A meta‑analysis of randomized controlled trials

“…High-burden thrombosis is the most important risk factor for no reflow or slow blood flow phenomena following PCI ( 32 ). Thrombus aspiration (TA) is a common method used for treating intracoronary thrombus, but TA cannot completely remove the thrombus and no reflow rate is still high following emergency PCI ( 33 ).…”

Hemoglobin A1c levels and thrombus load in patients with type 2 diabetes mellitus and non-ST-segment elevation myocardial infarction

“…The thrombus load in the infarct-related artery was scored using the TIMI thrombus grade. This grading system included six categories, ranging from no cineangiography characteristics of thrombus present (TIMI grade 0) to chronic total occlusion with extensive collateralization (TIMI grade 6) (9) .…”