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Научные статьи, исследования, монографии

Angiographic Quantification of Thrombus in ST-Elevation Acute Myocardial Infarction Presenting with an Occluded Infarct-Related Artery and Its Relationship with Results of Percutaneous Intervention

FAUSTINO MIRANDA-GUARDIOLA, M.D.,1 ANGELICA ROSSI, M.D.,1 ANTONIO SERRA, M.D.,1
BRUNO GARCIA, M.D.,2 JOS ´E RAM´ON RUMOROSO, M.D.,3 ANDR´ES´IN˜ IGUEZ, M.D.,4

Ангиографическое количественное определение тромбоза при инфаркте миокарда с подъемом сегмента ST в пораженной инфаркт-зависимой артерии и его связь с результатами первичного чрезкожного вумешательства

Introduction: Routine thrombectomy has been advocated for ST-segment-elevation myocardial infarction (STEMI), but it is unknown how many patients present with a large thrombus.We aimed to quantify the intracoronary thrombusin STEMI and to correlate it with procedure results.
Methods: In 98 patients with STEMI and TIMI flow grades 0–2 in the infarct-related artery, thrombus was qualified as small (ST) when its maximal dimension was <2 vessel diameters and large (LT) when ≥2. Main
outcome measures were TIMI flow, myocardial blush grade (MBG), corrected TIMI frame count (cTFC), and ST-segment elevation resolution (STSER).
Results: Only a third of the patients presented with an LT. Thrombus grade was independent of the initial vessel patency. Diabetes (OR 3.1, 95% CI 1.20–8.02, P = 0.027) and pretreatment with clopidogrel (OR 0.27, 95% CI 0.08–0.86, P = 0.034) were independent predictors of LT. LT was an independent predictor of unfavorable results: <3 TIMI flow (OR 2.87, 95% CI 1.04–8.00, P = 0.043), MBG 0–1 (OR 3.36, 95% CI 1.10–10.26, P = 0.033), cTFC > 21 (OR 2.86, 95% CI 1.09–7.49, P = 0.033) and <50% STSER (OR 3.19, 95% CI 1.06–9.63, P = 0.039). Conclusion: Only a third of STEMI patients present with an LT, being diabetes and lack of clopidogrel pretreatment independent predictors. An LT is strongly associated with worse PCI results. (J Interven Cardiol 2009;∗∗:1–9)

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