Coronary Thrombus Research Articles

Abstract 13185: Getting at the Heart of Allergies: A Case Series on Kounis Syndrome

Kounis Syndrome (KS) is a complex medical condition where acute coronary syndrome coincides with allergic reactions. KS presents a unique clinical challenge due to its varied presentation and simultaneous management of an allergic response and a cardiac event. This study aims to further our understanding of this underreported condition to improve outcomes in patients. We demonstrated the intricacies of KS by examining two case studies. In Case 1, a 51-year-old male suffered a myocardial infarction after a wasp sting. Workup revealed elevated tryptase levels and mastocytosis on bone marrow biopsy concerning for mast cell activation syndrome. In Case 2, a 48-year-old female was diagnosed with vasospastic angina exacerbated by exposure to various allergens and associated with elevated histamine levels. Both patients underwent coronary angiography which demonstrated no obstructive coronary artery disease. Functional coronary angiography with acetylcholine provocation confirmed a predisposition for coronary vasospasm. Both patients were treated with anti-anginals and antihistamines. A literature review was performed to describe the pathophysiology, diagnosis, and treatment of KS. The underlying pathophysiology includes mast cell degranulation, where the release of inflammatory mediators like histamine and tryptase provokes coronary vasospasm, plaque rupture, and thrombus formation. With prompt recognition and appropriate management, the prognosis of KS is favorable. A greater understanding of KS can support clinicians in delivering quality care for patients. Our cases demonstrate the importance of maintaining a high index of suspicion in patients exhibiting an acute allergic reaction with concurrent evidence of cardiac ischemia. While the current literature provides some management guidance, additional research is required to improve our mechanistic understanding, diagnostic criteria, and therapeutic strategies.

Abstract 14990: A Propensity Score Analysis of Five-Year Outcomes After Coronary Thrombus Aspiration in Acute Myocardial Infarction: Insights From the FAST-MI Real-Life Registry

Introduction: Though previous trials and registries have shown no short-term benefit of thrombectomy in acute myocardial infarction (AMI), data on long-term outcomes are lacking. Hypothesis: Use of coronary thrombectomy in real-life conditions does not affect 5-year outcome. Methods: FAST-MI program consists of 3 nationwide French surveys (2005, 2010, 2015), including consecutive AMI patients over a 1-month period. This analysis focused on patients undergoing percutaneous coronary intervention (PCI, N=9,731). Five-year follow-up is >96%. Results: Thrombectomy was used in 1,781 patients (18%; 2005: 7%, 2010: 27%, 2015: 18%), 87% of them had STEMI. They were younger (61±13 vs 65±14 yo), mostly men (81% vs 74%, p<0.001), with less multivessel coronary artery disease (47% vs 55%, P<0.001) and a culprit lesion mostly on the right coronary artery (40% vs 31%, P<0.001). Crude in-hospital death was higher with thrombectomy (3.1% vs 2.0%, P=0.005) but 5-year death lower (13% vs 17%, P<0.001; crude HR 0.74 [95%CI 0.66-0.82]). After adjustment on the propensity score (PS) for getting thrombectomy, OR for in-hospital death was 1.24[95%CI 0.82-1.87] and HR for 5-year death: 0.95 [95%CI 0.79-1.14], P=0.58. In hospital survivors, Cox multivariate adjustment including discharge medications yielded similar results (HR 0.96, 95%CI 0.76-1.21, P=0.73). After PS matching, the two cohorts (N=1,430 each) had even distributions for all baseline characteristics and medications. In-hospital death was similar (2.7% vs 2.6%, P=0.91) but stroke was numerically higher (0.8% vs 0.3%, P=0.13) with thrombectomy. Five-year survival was similar in the 2 cohorts: HR 0.93, 95%CI 0.75-1.14, P=0.46. (Figure) Conclusions: These real-world data show that the use of thrombectomy has increased until 2010 and declined thereafter, in keeping with international guidelines, and suggest that thrombectomy has no beneficial nor detrimental effect on long-term survival compared to PCI alone.

Abstract 16915: Considerations in Management of Cocaine-Induced Coronary Disease and Embolism

Background: Coronary embolism accounts for ~3% of cases of myocardial infarction (MI). We describe a case of a young patient with cocaine abuse with coronary thrombus resulting in acute coronary syndrome (ACS). Case: 33-year-old male with no known medical history seen in the ER with one hour of typical chest pain. EKG showed ST-segment elevations in inferior leads. Coronary angiogram demonstrated a hazy filling defect in the distal RCA as well as a 100% thrombotic occlusion of the right posterolateral branch of RCA likely due to distal embolization. Aspiration thrombectomy was performed with no residual stenosis. All other vessels were angiographically normal. Decision-Making: Our patient had no traditional coronary artery disease risk factors. Work-up for other coronary embolism causes and genetic thrombophilia was negative. We aspirated the thrombi rather than stenting, as stent thrombosis risk is >10-fold in cocaine users in absence of any residual stenosis. Dual antiplatelet therapy was initiated given ACS presentation. Conclusion: Acute coronary thrombosis is a life-threatening complication of cocaine abuse. In lack of residual stenosis post-aspiration thrombectomy, stenting can be avoided due to high stent thrombosis risk in this patient population.

Design and rationale of the ATTRACTIVE trial: a randomised trial of intrAThrombus Thrombolysis versus aspiRAtion thrombeCTomy during prImary percutaneous coronary interVEntion in ST-segment elevation myocardial infarction patients with high thrombus burden

IntroductionST-segment elevation myocardial infarction (STEMI) with high thrombus burden is associated with a poor prognosis. Manual aspiration thrombectomy reduces coronary vessel distal embolisation, improves microvascular perfusion and reduces cardiovascular deaths,...

A canine acute coronary occlusion model using thrombus implantation by percutaneous coronary intervention

AbstractObjectiveTo establish an acute canine coronary artery occlusion model by implanting a mixed thrombus prepared in vitro into the coronary artery by percutaneous coronary intervention (PCI).MethodsThis study included 14 healthy Beagle dogs aged 10–13 months. First, 5 ml of canine venous blood was drawn to prepare the coronary artery thrombus in vitro. The thrombus was then implanted into the canine coronary artery by PCI to establish an animal model of acute coronary artery occlusion. Dogs were randomly divided into two experimental groups: group A, in which dogs were assessed for 2 h after coronary occlusion, and group B, in which dogs were assessed for 4 h after surgery. Baseline and postoperative assessment included cardiac troponin T (cTnT) levels, electrocardiography (ECG), plain and contrast echocardiography, and large‐scale digital subtraction angiography (DSA).ResultsCanine venous blood was successfully used to prepare a mixed thrombus with reticular fibrin structure and activated platelets in vitro. After the mixed thrombus was implanted into the coronary artery, large‐scale DSA showed no contrast medium perfusion, confirming complete occlusion of the coronary artery. After the coronary artery occlusion, dogs in both groups showed ST segment elevation >0.5 MV, a 0.9 μg/L increase in CTnT (p < 0.001), and increased EDV and ESV. Dogs also showed decreased left ventricular EF and FS and decreased MBF in the infarcted area (p < 0.05).ConclusionsAn experimental model of acute coronary artery occlusion in dogs was successfully established by implanting a mixed thrombus developed in vitro into the coronary artery using minimally invasive PCI.

High CRP-albumin ratio is associated high thrombus burden in patients with newly diagnosed STEMI.

In patients undergoing primary percutaneous coronary intervention (pPCI) due to ST-segment elevation myocardial infarction (STEMI), an increased intracoronary thrombus burden is a strong predictive factor for adverse cardiovascular events. The C-reactive protein (CRP)-serum albumin (SA) ratio (CAR), used as an inflammatory marker, is closely associated with thrombogenicity. In this study, we investigated the relationship between coronary thrombus burden and CAR in patients undergoing pPCI due to newly diagnosed STEMI. A total of 216 patients who underwent pPCI due to STEMI were retrospectively included for the study. Angiographic thrombus burden was assessed according to thrombolysis in myocardial infarction (TIMI) grading, and those with grade 1, 2, 3 were classified as low thrombus burden (n = 120) and those with grade 4, 5 were classified as high thrombus burden (HTB) (n = 96). CAR was calculated as the ratio of CRP to SA. The average age of the patients was 60 ± 9.8, and the male ratio was 61.1. Compared to the LTB group, the HTB group had higher CAR, age, SYNTAX score, baseline cTnT, peak cTnT, CRP, glucose, WBC, and NLR while the LVEF and SA levels were lower (P < .05). Spearman's correlation analysis revealed a significant correlation between thrombus burden and CAR. The multivariable logistic regression analysis revealed that CAR (odds ratio: 10.206; 95% confidence interval: 2.987-34.872, P < .001) was a independent risk factor for HTB. According to the receiver operating characteristic (ROC) analysis, when the cutoff value for CAR was taken as ≥1.105 CAR could predict HTB with a sensitivity of 70.8% and specificity of 67.7%. Our data indicate that CAR an independent risk factor for thrombus burden.

Effect of optimized thrombus aspiration on myocardial perfusion and prognosis in acute ST-segment elevation myocardial infarction patients with primary percutaneous coronary intervention.

To investigate the impact of optimized thrombus aspiration on myocardial perfusion, prognosis, and safety in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention(primary PCI). A total of 129 patients with STEMI were randomly allocated into control group (Subgroup A and B) and experimental group(Subgroup C and D). Control group received percutaneous transluminal coronary angioplasty (PTCA),thrombus aspiration and primary PCI. Experimental group received optimized thrombus aspiration and primary PCI. The number of thrombus aspiration was less than 4 times in Subgroup A and C. The number of thrombus aspiration was performed more than 4 times in Subgroups B and D. The classification of thrombi extracted, the TIMI flow grade, the incidence of no-reflow and slow flow, cTFC, TPI and CK-MB at 12 h and 24 h after stenting, ST segment resolution of ECG after stenting, NT-proBNP, LVEFat 24 h, 30 days and 180 days after stenting were compared between groups. The incidence of intraoperative and postoperative bleeding complications, stroke events and major cardiovascular events (MACE) were recorded and compared between groups. The classification of thrombi extracted in the experimental group was higher than that in the control group. The TIMI flow grade of the experimental group was better than the control group after thrombus aspiration. After stenting, the advantage still existed, but the difference was not statistically significant. On cTFC, the experimental group was lower than the control group, but the difference was not statistically significant; After stenting the experimental group was significantly lower than the control group. The CK-MB at 12 h and 24 h of the experimental group was lower than the control group. After thrombus aspiration the incidence of no-reflow in the experimental group was significantly lower than that in the control group; after stenting the incidence of no-reflow in the experimental group was still lower than the control group, but no statistically difference. After thrombus aspiration and stenting the incidence of slow flow in the experimental group were lower than that in the control group. After stenting, NT-proBNP at 24 h was lower in the experimental group than that in the control group, However, there was no statistical difference; after stenting, The NT-proBNP in the experimental group was lower than that in the control group at 30 days and 180 days. After stenting, LVEF of the experimental group was significantly higher than the control group at 24 h and 30 days; superiority remained after 180 days but no statistical difference. There was no statistical difference between two groups for intraoperative and postoperative bleeding complications, stroke events, and MACE events. In Subgroup analysis,there was no significant difference in the classification of thrombi extracted, TIMI flow grade, cTFC, CK-MB,NT-proBNP and LVEF between group C and D, but group A was better than group B. Analysis of variance showed that the optimal number of suction was 4-5 times. Optimized thrombus aspiration can significantly improve myocardial perfusion and short-term and medium-term prognosis of STEMI patients after PCI, and reduce the incidence of slow flow and no-reflow. The optimal suction times were 4-5 times. Traditional aspiration method with more aspiration times is harmful to cardiac prognosis. Thrombus aspiration does not increase the incidence of stroke events and is safe.Clinical Trial Registration: identifier, ChiCTR2300073410.

Impact of epicardial adipose tissue on coronary arteries thrombus burden and early outcomes in STEMI patients

Abstract Aim Evaluation the relationship between the epicardial adipose tissue thickness (EAT), the coronary arteries thrombus burden and the early major adverse cardiovascular events (MACE) in patients presented with STEMI undergoing primary percutaneous coronary intervention. Method The study was prospective and included patients (n = 80) who were referred to the cardiology department in Alexandria University Hospitals with STEMI between the 1st of March 2021 and the last day of August 2022. Patient clinical, laboratory, angiographic and echocardiographic data were described. Patients were put under observation to detect the occurrence of any major adverse cardiovascular events either in hospital or during a period of 30 days follow up. Special concerns for measuring EAT as an echo free space between the myocardium and visceral epicardial and measured perpendicular to the free wall of the right ventricle in parasternal long and short axis views at end diastole and angiographic assessment of thrombus burden was scored as follows: 0 (no thrombus), 1 (possible thrombus), 2 (definite thrombus &amp;lt; 0.5× reference vessel diameter), 3 (definite thrombus 0.5–2× reference vessel diameter), 4 (definite thrombus &amp;gt;2× reference vessel diameter), and 5 (complete vessel occlusion). According to thrombus grade the patients were grouped as low thrombus burden (grades 0–3) and high thrombus burden (grades 4 and 5). Results 25 subjects were in the low thrombus burden group and 55 in the high thrombus burden group. There were no differences in the two groups for age, sex, smoking and drug addiction status, family history of coronary artery disease, diabetes mellitus, hypertension, and total cholesterol, triglyceride, LDL-C and HDL-C, The mean Wall motion score and Wall motion score index. The means levels of high sensitivity troponin I and Creatine Kinase MB are measured higher in the low thrombus burden group with statistically significant difference (P = 0.025) and (P = 0.032). Balloon predilation was statistically significant difference between the two groups (P = 0.006). Thrombus’ aspiration, balloon post dilation of the culprit vessel, GpIIb/IIIa inhibitors, and one stent only were insignificant difference between the two groups. The receiver operating characteristic curve analysis was undergone to determine the cutoff value of EAT to predict the presence of high thrombus burden setting a significance level at P &amp;lt; 0.05. The thickness of 2.48 mm for EAT has 74.55% sensitivity and 72.0% specificity for prediction of the high thrombus burden. The predictors of the high thrombus burden were analyzed by univariate analysis shows EAT, the waist circumference, Wight, the body mass index, and balloon predilation were found as an independent predictors of high thrombus burden. The multivariate analysis shows EAT and balloon predilation were found as an independent predictors of high thrombus burden. The overall MACE at 30 day follows up has statistically insignificant difference between low and high thrombus burden groups. There was statistically insignificant difference between patients with or without MACE according to epicardial adipose tissue thickness. Conclusion EAT was an independent predictor of coronary thrombus burden in STEMI patients. Additional Content An author video to accompany this abstract is available on https://academic.oup.com/eurheartjsupp. Please click on the arrow next to ‘More Content’ and then click on ‘Author videos’.

Association Between Left Atrial Appendage Thrombus Formation and Monocyte/HDL Ratio in Patients with Acute Ischemic Stroke

Objective: There is an apparent link between thrombus formation and inflammation. Monocyte/HDL ratio (MHR) has been determined as an inflammatory marker and associated with many cardiovascular disorders like coronary artery disease, acute coronary stent thrombus, coronary thrombus burden and atrial fibrillation (AF). The purpose of this study was to elucidate the association between MHR and left atrial appendage thrombus formation (AATF) in patients with acute ischemic stroke.&#x0D; Methods: A total of 69 patients with the diagnosis of acute ischemic stroke were retrospectively enrolled in the study. Demographic, clinical and echocardiographic data were collected retrospectively from the patients’ records. MHR and neutrophil/lymphocyte ratio (NLR) were calculated from the present laboratory data.&#x0D; Results: There was a significant positive correlation between MHR and NLR (r=0.6; p

Coronary thrombus after cannabis consumption: the important role of intracoronary imaging modalities

Coronary thrombus after cannabis consumption: the important role of intracoronary imaging modalities

Scary Acute Left Main Coronary Artery Thrombus as an Initial Presentation of a Hereditary Thrombophilia: When to Go Out of Routine?

Patients with either hereditary or acquired thrombophilia can present with arterial and venous thrombotic complications. However, it is unclear to whom the thrombophilia panel should be assessed, particularly in patients presenting with a common cardiovascular risk factor and acute coronary thrombus. Herein, we presented the management of an active smoker female patient who presented to our emergency room with inferior acute ST-segment elevation myocardial infarction, and hereditary thrombophilia has been diagnosed due to the presence of substantial left main coronary artery thrombus.

Latest Concepts in Diagnosis and Management of Coronary Thrombus

Coronary thrombus is an integral part of unstable atherosclerotic plaque causing acute coronary syndrome. The thrombus results from a either a disrupted atherosclerotic plaque or plaque erosion. A vulnerable plaque initiates the formation of a thrombus which consists of platelets, red blood cells, vasoconstrictors, and procoagulant bound by fibrin fibers. intracoronary thrombi (ICT) can be red or white. Angiography is the gold standard for diagnosis of coronary thrombus. Thrombus burden inversely impacts myocardial perfusion, with high thrombus burden resulting in sub optimal primary percutaneous coronary intervention (PCI) results and poor outcome. Management of ICT is a therapeutic challenge and involves a combination of pharmacological and mechanical therapies. Low thrombus burden is dealt with standard pharmacotherapy, balloon angioplasty, and stenting with occasional need to use aspiration catheter. High thrombus burden requires a targeted thrombus strategy.

The value of serum Sema4D level in predicting the prognosis of patients with acute ST-segment elevation myocardial infarction and with high thrombus burden

BackgroundAcute ST-segment elevation myocardial infarction (STEMI) is a serious cardiovascular disease. High thrombus burden is an independent risk factor for poor prognosis of acute myocardial infarction. However, there is no study on the correlation between soluble semaphorin 4D (sSema4D) level and high thrombus burden in patients with STEMI.PurposeThis study aimed to investigate the relationship between sSema4D level and the thrombus burden of STEMI and further explore its effect on the main predictive value of the occurrence of major adverse cardiovascular events (MACE).MethodsFrom October 2020 to June 2021, 100 patients with STEMI diagnosed in our hospital’s cardiology department were selected. According to the thrombolysis in myocardial infarction(TIMI)score, STEMI patients were divided into high thrombus burden groups (55 cases) and non-high thrombus burden groups (45 cases) 0.74 patients with stable coronary heart disease (CHD) were selected as stable CHD group, and 75 patients with negative coronary angiography (CAG) were selected as control group. Serum sSema4D levels were measured in 4 groups. The correlation between serum sSema4D and high-sensitivity C-reactive protein (hs-CRP) in patients with STEMI was analyzed. The relationship of serum sSema4D levels between the high and non-high thrombus burden group was evaluated. The effect of sSema4D levels on the occurrence of MACE was explored in one year after percutaneous coronary intervention.ResultsSerum sSema4D level was positively correlated with hs-CRP level in STEMI patients (P < 0.05) with a correlation coefficient of 0.493. The sSema4D level was significantly higher in the high versus non-high thrombus burden group (22.54(20.82,24.17), P < 0.05). Moreover, MACE occurred in 19 cases in high thrombus burden group and 3 cases in non-high thrombus burden group. The results of Cox regression analysis showed that sSema4D was an independent predictor of MACE (OR = 1.497,95% CI: 1.213–1.847, P < 0.001).ConclusionThe sSema4D level is associated with coronary thrombus burden and is an independent risk factor for MACE.

The prediction of angiographic coronary thrombus burden using the admission GRACE 2.0 score in ST-elevation myocardial infarction patients

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Heavy coronary thrombus burden is associated with increased periprocedural complications in ST-elevation myocardial infarction (STEMI) patients undergoing primary PCI (PPCI)[1]. The prediction of such a burden can help in planning the PPCI procedure in the best way. The Global Registry of Acute Coronary Events (GRACE) 2.0 score is a useful non-invasive tool to predict major adverse events in STEMI patients [2]. Purpose to assess the difference in coronary thrombus burden in STEMI patients with low and high risk GRACE 2.0 score on admission. Methods We retrospectively studied 210 STEMI patients who presented to a single PPCI centre over a period of 6 months. We consecutively included all the patients who were eligible for PPCI according to the European Society of Cardiology (ESC) guidelines [2]. We excluded the patients who received fibrinolysis, who had a previous PCI and presented with in-stent thrombosis and those who presented more than 24 hours from the onset of chest pain. All procedures were done according to the Helsinki declaration of research on human beings. The study protocol was approved by the local research ethics committee. The GRACE 2.0 score was calculated at the time of presentation to the emergency department using the online calculator [3]. We divided the patients according to their GRACE 2.0 score into a high-risk score (more than 140) and a non-high-risk score(up to 140) groups according to the ESC guidance.2 We compared the two groups regarding various cardiovascular risk factors and the angiographic thrombus burden during the PPCI procedure. Two experienced interventional cardiologists (blinded to the allocation group) assessed the thrombus burden using the TIMI thrombus grades [4]. A heavy thrombus burden was defined as a thrombus grade of 4 or 5. A professional statistician carried out the statistical analysis using IBM SPSS 21.0 software. Results The baseline characteristics of the studied groups are shown in figure 1. Multivariate regression analysis did not show an influence of the different cardiovascular risk factors on the thrombus burden in the studied groups. The percentage of patients with a heavy thrombus burden was higher in the high-risk score group; however, the difference between the two groups was not statistically significant (44.6% vs 35.3%, P=0.46) (figure 2). This study is the first to assess the ability of the GRACE 2.0 score to predict the coronary thrombus burden in STEMI patients undergoing PPCI. The study is limited by the small number of patients included and the small geographical scale. Conclusion Although the GRACE 2.0 is a well-validated tool to predict the clinical prognosis in STEMI patients, it could not identify those patients with a high coronary thrombus burden in our small study. Further larger-scale studies are required to find other non-invasive tools to identify this high-risk cohort.

Admission heart failure and coronary perfusion in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Studies demonstrated a link between the presence of HF on the admission of ACS patients and increased in-hospital morbidity and mortality. However, the literature did not establish the connection between the admission HF and the angiographic burden and the coronary vessel perfusion post-PPCI. Purpose To establish the correlation between acute HF on admission of STEMI patients, the coronary thrombus burden and the final coronary perfusion post PPCI. Methods We retrospectively studied 210 STEMI patients who presented to a single PPCI centre. We excluded post-fibrinolysis patients, patients with old stents and those who presented more than 24 hours after the onset of pain. We divided the studied cohort into two subgroups based on the presence of HF on presentation to the emergency department. We obtained Informed consent from all patients, and all procedures were done in compliance with the Helsinki declaration for research on human beings. Two blinded interventional cardiology consultants assessed the thrombus burden and coronary flow using TIMI grades of both variables. Results 20 patients (10%) of the studied group had HF on admission. There was no significant difference between the two subgroups regarding other cardiovascular risk factors (figure 1). The coronary thrombus burden did not differ significantly between the HF and no HF subgroups (50% vs 43.16%, respectively, p=0.557). However, the incidence of impaired coronary flow post-PPCI was significantly higher in the HF group (25% vs 8.4%, p=0.019) (figure 2). Multivariate logistic regression analysis showed that admission HF is an independent predictor of impaired perfusion post-PPCI ( OR= 5.49, 95% CI=1.54-19.49, p=0.01). Our study demonstrates the association between admission HF in STEMI patients undergoing PPCI and increased incidence of impaired coronary flow after PPCI. This finding was independent of the heavy coronary thrombus burden on angiography. Animal studies have demonstrated impaired coronary flow even in HF secondary to non-ischaemic causes.1,2 Possible mechanisms include impaired nitric oxide-mediated endothelium-dependent vasodilatation and enhanced vasoconstriction to mediators of neurohumoral activation.3 These mechanisms can explain our study's impaired coronary flow in HF patients. Conclusion Admission HF is an independent predictor of reduced coronary blood flow after PPCI. Timely treatment of STEMI patients can prevent HF development and improve their prognosis.

Prepercutaneous coronary intervention Zalunfiban dose-response relationship to target vessel blood flow at initial angiogram in st-elevation myocardial infarction – A post hoc analysis of the cel-02 phase IIa study

Zalunfiban (RUC-4) is a novel, subcutaneously administered glycoprotein IIb/IIIa inhibitor (GPI) designed for prehospital treatment to initiate reperfusion in the infarct-related artery (IRA) before primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction (STEMI). Since GPIs have been reported to rapidly reperfuse IRAs, we assessed whether there was a dose-dependent relationship between zalunfiban treatment and angiographic reperfusion indices and thrombus grade of the IRA at initial angiogram in patients with STEMI. This was a post hoc analysis from the open-label Phase IIa study that investigated the pharmacodynamics, pharmacokinetics, and tolerability of three doses of zalunfiban - 0.075, 0.090 and 0.110 mg/kg - in STEMI patients. This analysis explored dose-dependent associations between zalunfiban and three angiographic indices of the IRA, namely coronary and myocardial blood flow and thrombus burden. Zalunfiban was administered in the cardiac catheterization laboratory prior to vascular access, ∼10 to 15 minutes before the initial angiogram. All angiographic data were analyzed by a blinded, independent, core laboratory. Twentyfour out of 27 STEMI patients were evaluable for angiographic analysis (0.075 mg/kg [n=7], 0.090 mg/kg [n=9], and 0.110 mg/kg [n=8]). TIMI flow grade 2 or 3 was seen in 1/7 patients receiving zalunfiban at 0.075 mg/kg, in 6/9 patients receiving 0.090 mg/kg, and in 7/8 patients receiving 0.110 mg/kg (ptrend=0.004). A similar trend was observed based on TIMI flow grade 3. Myocardial perfusion was also related to zalunfiban dose (ptrend=0.005) as reflected by more frequent TIMI myocardial perfusion grade 3. Consistent with the dose-dependent trends in greater coronary and myocardial perfusion, TIMI thrombus ≥4 grade was inversely related to zalunfiban dose (ptrend=0.02). This post hoc analysis found that higher doses of zalunfiban administered in the cardiac catheterization lab prior to vascular access were associated with greater coronary and myocardial perfusion, and lower thrombus burden at initial angiogram in patients with STEMI undergoing primary percutaneous coronary intervention.

Stress Hyperglycemia Ratio Is Associated With High Thrombus Burden in Patients With Acute Coronary Syndrome.

The blood glucose level at admission indicates (with some limitations) poor prognosis and thrombus burden in patients with the acute coronary syndrome (ACS). Our study aimed to measure the predictive value of the stress hyperglycemia ratio (SHR), an indicator of stress hyperglycemia, showing increased thrombus burden in patients with ACS. Patients (n = 1222) with ACS were enrolled in this cross-sectional study. Coronary thrombus burden was classified as high and low. SHR was calculated by dividing the admission serum glucose by the estimated average glucose derived from HbA1c. Low thrombus burden was detected in 771 patients, while high thrombus burden (HTB) was detected in 451 patients. SHR was found to be significantly higher in patients with HTB (1.1 ± .3 vs 1.06 ± .4; P = .002). SHR was determined as a predictor of HTB (odds ratio (OR) 1.547 95% CI (1.139-2.100), P < .001) as a result of univariate analysis. According to multivariate analysis, SHR was determined as an independent risk factor for HTB (OR 1.328 CI (1.082-1.752), P = .001). We found that SHR predicted thrombus burden with higher sensitivity than admission glucose level in patients with ACS.

How to effectively manage the refractory coronary thrombus? A systemic mini-review.

The main management principle for patients with coronary thrombus should be "more removal and less implantation". Routine thrombus aspiration (TA) is ineffective for intracoronary thrombus or high residual thrombus burden after TA and may result in a refractory coronary thrombus. It is unwise to implant a stent in the vessel with high residual thrombus, which is associated with no-reflow, impaired microvascular perfusion, and consequently worse clinical outcomes. Therefore, increasing the efficiency of TA during percutaneous coronary intervention procedures, especially under some conditions of refractory coronary thrombus, is very important to restore myocardial reperfusion and improve microvascular dysfunction early. In the present work, we aimed to demonstrate the factors that may affect TA efficiency and introduce several highly effective approaches to treat refractory coronary thrombus.

TCTAP C-160 Optical Coherence Tomography Guided Percutaneous Coronary Intervention of Spontaneous Recanalized Coronary Thrombus

TCTAP C-160 Optical Coherence Tomography Guided Percutaneous Coronary Intervention of Spontaneous Recanalized Coronary Thrombus

A modern view on the diagnostic role of endothelial dysfunction biomarkers and the possibilities of its correction

Highlights. The article presents a review of literature data on the diagnostic role of endothelial dysfunction biomarkers. The review provides an overview of the main indicators, their significance in various pathologies, and presents possible therapeutic strategies for preventing endothelial dysfunction.Abstract. Endothelial dysfunction is a characteristic feature of each stage of the cardiovascular continuum – a series of events from hypertension to the development of atherosclerosis and coronary heart disease, thrombus formation, myocardial infarction, and heart failure. Due to the prominent role of endothelial dysfunction in the pathogenesis of many vascular diseases, it is a significant therapeutic target. It is important to note that circulating markers of endothelial activation and damage characterize the severity of the disease and can be used to evaluate the efficacy of treatment and subsequent prognosis. The purpose of this review is to provide up–to-date data on endothelial function, discussing its clinical relevance in the cardiovascular continuum, the latest insights in molecular and cellular biology, and their implications for clinical practice, with a focus on new methods of therapeutic approaches for correcting endothelial dysfunction.