Determinants of angiographic thrombus burden in patients with ST-elevation myocardial infarction

Abstract

Aims: We aimed to investigate the determinants of angiographic thrombus burden in patients with ST elevation myocardial infarction (STEMI) who underwent to primary Percutaneous coronary intervention (PCI). Methods: The study population consisted of 662 patients with non-anemic STEMI who underwent to primary PCI. Clinical, laboratory and demographic properties of the patients were recorded Baseline hematologic indices were measured at time of admission. Angiographic coronary thrombus burden was scored based on TIMI thrombus grades. After wiring and/or small balloon dilation, patients with thrombus burden grade 4 and 5 was defined as high thrombus burden, patients with thrombus burden < grade 4 was defined as low thrombus burden. Results: Patients with high thrombus burden had more family history of coronary artery disease, longer pain-balloon time, higher Killip class (≥II), higher neutrophil-to-lymphocyte ratio (NLR), red cell distribution width (RDW), baseline creatine kinase musclebrain fraction (CK-MB) and baseline troponin, higher peak CK-MB and peak troponin; however, lower triglycerides. As an angiographically, Patients with high thrombus burden had longer lesion in the infarct-related artery, less frequent direct stenting, lower epicardial and myocardial perfusion, more frequent distal embolization, more frequent electrocardiographic and angiographic no-reflow. In multivariate logistic regression analysis only RDW (OR:1.29, 95% CI 1.19 – 1.39, p<0.001) was determined as independent predictors in the analysis. The area under the ROC curve of the RDW was 0.733 (0.690 – 0.776, P<0.001) to predict high TIMI thrombus burden. Conclusion: Present study results demonstrated that high thrombus burden in patients with STEMI were associated with impaired postprocedural epicardial and myocardial perfusion and higher no-reflow and distal embolization; and increased RDW values was independent predictors of coronary thrombus burden.