Abstract
Background: High coronary thrombus burden has been associated with unfavorable outcomes in patients with ST-segment elevation myocardial infarction (STEMI), the optimal management of which has not yet been established. Methods: We assessed the adjunctive catheter-directed thrombolysis (CDT) during primary percutaneous coronary intervention (PCI) in patients with STEMI and high thrombus burden. CDT was defined as intracoronary infusion of tissue plasminogen activator (t-PA; monteplase). Results: Among the 1849 consecutive patients with STEMI, 263 had high thrombus burden. Moreover, 41 patients received t-PA (CDT group), whereas 222 did not receive it (non-CDT group). No significant differences in bleeding complications and in-hospital and long-term mortalities were observed (9.8% vs. 7.2%, p = 0.53; 7.3% vs. 2.3%, p = 0.11; and 12.6% vs. 17.5%, p = 0.84, CDT vs. non-CDT). In patients who underwent antecedent aspiration thrombectomy during PCI (75.6% CDT group and 87.4% non-CDT group), thrombolysis in myocardial infarction grade 2 or 3 flow rate after thrombectomy was significantly lower in the CDT group than in the non-CDT group (32.2% vs. 61.0%, p < 0.01). However, the final rates improved without significant difference (90.3% vs. 97.4%, p = 0.14). Conclusions: Adjunctive CDT appears to be tolerated and feasible for high thrombus burden. Particularly, it may be an option in cases with failed aspiration thrombectomy.
Highlights
In patients with ST-segment elevation myocardial infarction (STEMI), the preferred reperfusion regimen is primary percutaneous coronary intervention (PCI) [1,2]
The therapeutic strategy for STEMI with high thrombus burden includes intracoronary thrombolysis, aspiration thrombectomy, distal embolic protection, excimer laser coronary angioplasty, balloon angioplasty, and stenting. Interventional cardiologists find it challenging to establish an optimal treatment for high thrombus burden. It has been reported in small case series and studies that intracoronary administration of tissue plasminogen activator (t-PA) reduces coronary thrombus and improves thrombolysis in myocardial infarction (TIMI) flow grade [7,8]
There were no significant differences in blood pressure, heart rate, maximum creatine kinase level, and maximum creatine kinase-MB level between the two groups
Summary
In patients with ST-segment elevation myocardial infarction (STEMI), the preferred reperfusion regimen is primary percutaneous coronary intervention (PCI) [1,2]. Interventional cardiologists find it challenging to establish an optimal treatment for high thrombus burden It has been reported in small case series and studies that intracoronary administration of tissue plasminogen activator (t-PA) reduces coronary thrombus and improves thrombolysis in myocardial infarction (TIMI) flow grade [7,8]. High coronary thrombus burden has been associated with unfavorable outcomes in patients with ST-segment elevation myocardial infarction (STEMI), the optimal management of which has not yet been established. Methods: We assessed the adjunctive catheter-directed thrombolysis (CDT) during primary percutaneous coronary intervention (PCI) in patients with STEMI and high thrombus burden. Conclusions: Adjunctive CDT appears to be tolerated and feasible for high thrombus burden It may be an option in cases with failed aspiration thrombectomy
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