Predictor Of High Thrombus Burden Research Articles

Monocyte count as an independent predictor of high thrombus burden in ST-elevation myocardial infarction patients undergoing percutaneous coronary intervention: A systematic review and meta-analysis.

Due to the lack of a prior comprehensive review and meta-analysis, the relationship between monocyte count and thrombus load in ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI) has not been adequately established. This was a systematic review and meta-analysis of multiple cohorts (retrospective and prospective) and cross-sectional studies.We queried electronic databases (PubMed, Google Scholar, and Cochrane Central) from their inception to April 2022. The included studies had patients who had undergone PCI treatment and were classified using thrombolysis in myocardial infarction thrombus grading. Dichotomous outcomes from the studies were presented as odds ratios with 95% confidence intervals while means ± standard deviation were presented for continuous outcomes. Means ± standard deviation of monocyte levels and odds ratios were pooled using an inverse variance-weighted random-effects model. I² statistics are used to evaluate heterogeneity across studies and subgrouping was performed to reduce the heterogeneity. Five eligible studies, consisting of 1426 patients were included, out of which 776 had a high thrombus burden. Pooled results after subgroup analysis showed a significant relationship between raised monocyte count and high thrombus burden (odds ratios = 1.44; 95% confidence interval = 1.06-1.96; P = .02; I2 = 71%). Post-subgroup pooled analysis revealed a statistically significant correlation between high thrombus burden and raised monocyte count. STEMI patients with a high thrombus burden show an increased monocyte count. A high monocyte count upon admission is a major indication of increased intracoronary thrombus burden in STEMI patients with PCI procedures.

Relation of Monocyte Count to Thrombus Burden in ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention

Objective: To determine the association of monocyte count to thrombus burden in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (P-PCI). Method: This analytical, cross-sectional study was done in the Angiography Department of Rawalpindi Institute of Cardiology, Rawalpindi from October 30, 2020 to April 30, 2021. After taking ethical approval, 180 STEMI patients undergoing P-PCI who presented within 24 hours of symptoms were included using nonprobability convenient sampling. Informed written consent of the patients was obtained. Primary PCI with stenting was done and the thrombolysis in myocardial infarction (TIMI) scale was applied to determine intracoronary thrombus burden. The blood samples of patients were taken to estimate monocyte count. The data was analyzed through the Statistical Package for the Social Sciences (SPSS) version 25. Results: The frequency of thrombus burden was high in 71(39.4%) patients and low in 109(60.6%) patients. The monocyte count showed a significant difference in patients with high thrombus versus low thrombus burden. In low thrombus burden patients, the mean monocyte count was 0.49±0.50 and in high thrombus burden patients, the mean monocyte count was 0.64±0.48. The results of stratification of thrombus burden with age group showed significant p-value and with others showed non-significant p-value. Conclusion: The monocyte count is a reliable, inexpensive and simple-to-measure predictor of high thrombus burden in coronary arteries in STEMI patients undergoing primary PCI

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.

Relationship between intracoronary thrombus burden and systemic immune-inflammation index in patients with ST-segment elevation myocardial infarction

Aim This study aimed to evaluate the relationship between intracoronary thrombus burden and systemic immune-inflammation index (SII) and to compare the predictive capacity of SII together with the neutrophil-lymphocyte ratio (NLR), and the platelet-lymphocyte ratio (PLR) in patients with ST-elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PPCI) Patient & methods A total of 425 patients were included in the study. The clinical, laboratory, and demographic characteristics of the patients were recorded. The thrombus classification "Thrombolysis in myocardial infarction (TIMI)" was used to assess the intracoronary thrombus burden. According to the TIMI thrombus classification, 229 (54%) patients with low thrombus burden (grade 0–3) and 196 (46%) patients with high thrombus burden (grade 4 and 5) were compared. SII was calculated as platelet × neutrophil/lymphocyte counts. Results High NLR (OR: 1.068, 95% CI:1.023–1.404; p = 0.031), PLR(OR: 1.012, 95% CI:1.002–1.018; p = 0.043), SII(OR: 1.325, 95% CI: 1.156–1.879; p = 0.015) and low left ventricle ejection fraction (LVEF) (OR: 0.957, 95% CI:0.924–0.990; p = 0.012) were found to be independent predictors of high thrombus burden. SII values above 812 predicted a high thrombus burden with a sensitivity of 82% and specificity of 73% (AUC: 0.836; 95% CI:0.795–0.877; p < 0.001). This predictiveness of SII was stronger as compared to NLR (0.836 vs. 0.818, p = 0.043) and PLR (0.836 vs. 0.780, p < 0.001). Conclusion SII is an independent predictor of high thrombus burden in patients with STEMI. In addition, SII is superior to NLR and PLR in this regard.

Association between serum SCUBE1 levels and thrombus burden in patients with ST-segment elevation myocardial infarction

Introduction The signal peptide-CUB-EGF domain-containing protein-1 (SCUBE1) is a recently available biomarker which is expressed by activated and adhered platelets. In present study, we aimed to investigate the association between SCUBE1 levels and thrombus burden in patients with ST elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PPCI). Methods A total of 88 patients who were diagnosed with STEMI and underwent PPCI were prospectively included between July 2019 and August 2019. Blood samples were collected for routine biochemistry and serum SCUBE1 levels before PPCI and antiplatelet therapy. Angiographic coronary thrombus burden was classified based on thrombolysis in myocardial infarction (TIMI) thrombus grades. We formed two groups based on the thrombus grade: 37 (42%) patients had high thrombus burden whereas 51 (58%) patients had low thrombus burden. Results The mean age of study population was 58.2 ± 11.8 years (34% female). The mean peak troponin I level, SCUBE1 level, SYNTAX score, and pain-to-balloon time were significantly higher in the high thrombus burden group compared to the low thrombus burden group (p < .05, for all). In ROC analysis, SCUBE1 level >65.63 ng/dL had a sensitivity of 91.9% and a specificity of 76.6% to predict high thrombus burden (AUC: 0.9256; p < .001). In multivariate analysis, SCUBE1 level (HR: 1.133, p = .004) and troponin (HR: 1.002; 95% CI 1.001–1.004, p = .003) were independent predictors of high thrombus burden. Conclusion In the present study, we showed that SCUBE1, a novel platelet-endothelial adhesion molecule and a marker of platelet activation, is an independent predictor of high thrombus burden in patients with STEMI.

Predictive accuracy of CHA2DS2-VASc score in determining the high thrombus burden in patients with non-ST-elevation myocardial infarction

Background The presence of intracoronary thrombus is associated with increased ischaemic complications in patients with NSTEMI. High thrombus burden is an independent predictor of major adverse cardiovascular events, stent thrombosis and no reflow in patients with STEMI. CHA2DS2-VASc score predicts thrombus burden in STEMI patients undergoing primary percutaneous coronary intervention. However, the association between CHA2DS2-VASc score and high thrombus burden in patients with NSTEMI is unknown. The purpose of this study was to evaluate the predictive value of CHA2DS2-VASc score for a high pre-procedural intracoronary thrombus burden in patients with NSTEMI who underwent PCI. Methods We performed a retrospective analysis of 251 patients with NSTEMI who underwent PCI during their hospitalisation at our tertiary referral centre. Results The mean age of the 251 patients was 57.7 ± 10.9 years. Our patients were predominantly male (79%). There were 57 patients (22.7%) in the high-thrombus burden group, and 194 patients (77.2%) in the low-thrombus burden group. Higher CHA2DS2-VASc score, increased baseline serum CRP level, lower serum albumin level and decreased lymphocyte counts were found to be independently correlated with the high intracoronary thrombus burden in multivariate Cox regression analysis. Receiver-operating characteristics analysis revealed the cut-off value of CHA2DS2-VASc score >2 as a predictor of high thrombus burden with a sensitivity of 74% and a specificity of 61%. Conclusions CHA2DS2-VASc score can be used as a simple and reliable tool to predict high thrombus burden in NSTEMI patients undergoing PCI.

Relationship between epicardial adipose tissue thickness and coronary thrombus burden in patients with ST-elevation myocardial infarction.

Epicardial fat reflects abdominal visceral adiposity and visceral fat plays an important role in the development of an unfavorable metabolic and atherosclerosis risk profile. Intracoronary thrombus burden is an important factor affecting the success of the procedure particularly in patients undergoing percutaneous coronary intervention (PCI). Therefore, determining the factors predicting thrombus burden has great importance in predicting adverse cardiovascular events as well as determining the most appropriate treatment strategy to prevent failure in PCI. The aim of the current study was to evaluate the relationship between Epicardial adipose thickness (EAT) and thrombus burden in the patients with ST-elevation myocardial infarction (STEMI) who undergo primary PCI (pPCI). The study was prospective and included patients (n=156) who were referred to Kosuyolu Research and Education hospital with STEMI between 2016 and 2017. Thrombus burden was scored as follows: 0 (no thrombus), 1 (possible thrombus), 2 (definite thrombus <0.5xreference vessel diameter), 3 (definite thrombus 0.5-2xreference vessel diameter), 4 (definite thrombus >2xreference 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). EAT, identified as an echo-free space between the myocardium and visceral pericardium, was measured perpendicularly, on the free wall of the right ventricle at both parasternal long- and short-axis views at end-diastole in three cardiac cycles. Fifty-one subjects were in the low thrombus burden group and 105 in the high thrombus burden group. There were no differences in the two groups for LVEF, smoking status, family history of coronary artery disease (CAD), diabetes mellitus (DM), hypertension (HT), and hypercholesterolemia and for total cholesterol, triglyceride, GFR, LDL-C and HDL-C. In multivariate logistic regression analysis the EAT (odds ratio: 2.53, 95% CI: 1.76-3.67; p < .001) was found as an independent predictor of high thrombus burden. The present study showed that EAT was an independent predictor of coronary thrombus burden in STEMI.

Association of the Monocyte to HDL Cholesterol Ratio with Thrombus Burden in Patients with Acute Coronary Syndrome

Background: Intracoronary thrombus burden is associated with some adverse events and poor prognosis in patients with Acute Coronary Syndrome. Identifying predictors of the intracoronary thrombus burden may contribute to the management of Acute Coronary Syndrome. Objective: To assess the correlation between the Monocyte to HDL Cholesterol ratio with thrombus burden in patients with Acute Coronary Syndrome. Patients and Methods: 138 patients with ACS who were admitted to CCU department in National Heart Institute Cairoand Menoufia University Hospitals, Menoufia, underwent primary percutaneous coronary intervention (PCI).Angiographic thrombus burden was classified based on thrombolysis in myocardial infarction (TIMI) thrombus grades. The patients were grouped into 2 categories of low thrombus burden (grades 0 - 3) (49.7%) and high thrombus burden (grades 4 and 5) (50.3%). Results: On analysis we found that the MHR was significantly higher in the high thrombus burden group compared with the low thrombus (0.052 ± 0.019 vs 0.014 ± 0.008); P 0.001. Conclusion: Among Acute Coronary Syndrome patients underwent Primary PCI, MHR was independent predictor of high thrombus burden in patients with Acute Coronary Syndrome.

Correlation of Leukocyte and Coronary Lesion Severity of Acute Myocardial Infarction.

Leukocytes play a pivotal role in the onset and progression of acute myocardial infarction (AMI). We evaluated the relationship between leukocyte count and coronary lesion severity of AMI. We carried out a retrospective study involving 815 patients with AMI undergoing primary percutaneous coronary intervention from 2005 to 2014 at a cardiovascular center. We recorded their risk factors, routine blood parameters, and cardiovascular events during hospitalization. When thrombus and nonthrombus burden groups were compared, leukocyte count (9.55 [7.80, 12.29] vs 10.70 [8.67, 13.04]×109/L, P = .005), neutrophil count (7.48 [5.65, 10.18] vs 8.61 [6.61, 10.80]×109/L, P = .001), and neutrophil-lymphocyte ratio (NLR; 4.99 [2.97, 7.16] vs 10.70 [8.67, 13.04], P = .003) were significantly different. Patients in the total occlusion group showed higher leukocyte count, neutrophil count, and NLR compared to the nontotal occlusion group. After multivariate logistic analysis, a neutrophil count ≥8.355 × 109/L was independently associated with high thrombus burden and total coronary occlusion. Leukocyte count, neutrophil count, or NLR was not significantly related to cardiovascular events during hospitalization. In conclusion, the neutrophil count might be an independent predictor of high thrombus burden and total coronary occlusion.

Intrinsic platelet reactivity and thrombus burden in patients with ST-elevation myocardial infarction

IntroductionIn patients with ST elevation myocardial infarction (STEMI) increased platelet reactivity has been described to affect the primary percutanuous coronary intervention (PPCI) outcome. We aimed to evaluate the predictive accuracy of intrinsic platelet reactivity for intracoronary thrombus burden in P2Y12 inhibitor- naïve STEMI patients. Patients and MethodsIn a prospective, observational, cohort study we enrolled 94 consecutive STEMI patients undergoing PPCI, subjected to platelet reactivity assessment prior to any P2Y12 blockade, with visible angiographic thrombus in the infarct related artery (stratified as Grade A, B and C). Platelet-function testing was performed with the VerifyNow point-of-care P2Y12 assay immediately prior to intervention. ResultsIntrinsic platelet reactivity was higher with greater thrombus burden: Grade A 158.8±51.1 PRU, Grade B 217.4±62.1 PRU and Grade C 243.4±58.6 PRU, p=0.009 and Spearman r=0.32 (0.12-0.49 95% CI), p=0.002. ROC analysis revealed an AUC=0.7 (Standard error 0.07, p=0.03). An intrinsic platelet reactivity value of >220 PRU had 65% sensitivity (53–76 95%CI), 76% specificity (55–91 95%CI), 88% positive predictive value (76–96 95%CI) and 44% negative predictive value (29–60 95%CI) for detection of high thrombus burden. In multivariate analysis intrinsic platelet reactivity >220 PRU emerged as an independent predictor of high thrombus burden (RR=1.5, 1.15-2.07 95% CI, p=0.004). ConclusionsIn patients admitted with STEMI the intrinsic platelet reactivity -as assessed by a point-of-care assay- is positively associated with the degree of intracoronary thrombus, while having a moderate accuracy in predicting high thrombus burden.