Otaal Parminder S, Anand Abhinav, Vijayvergiya Rajesh
Cardiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, IND.
Internal Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, IND.
Cureus. 2020 Dec 10;12(12):e12017. doi: 10.7759/cureus.12017.
Background Variable residual thrombus ranging from minimal to a large thrombus is seen in the culprit vessel after successful thrombolysis in ST-elevation myocardial infarction (STEMI). Factors associated with residual thrombus in thrombolysed patients are poorly understood. The objective of our study was to determine the correlates of residual thrombus burden in successfully thrombolysed STEMI patients receiving dual antiplatelet therapy. Methods In this prospective observational study of 60 successfully thrombolysed STEMI patients receiving dual antiplatelet therapy, various clinical and coronary angiographic features like residual thrombus burden, residual stenosis, and thrombolysis in myocardial infarction (TIMI) flow grade in the infarct-related artery were evaluated. Results Out of 60 patients, 49 and 11 patients, respectively, had low and high thrombus burden. Thirty-seven (75.5%) patients amongst low-grade thrombus had TIMI 3 flow, whereas seven (63.6%) amongst high thrombus burden had TIMI 2 flow indicating an association between residual thrombus burden and TIMI flow grade, which was statistically significant (p=0.009). Further, amongst the 39 patients who were 45 years old, a statistically significant association of age and residual stenosis (p = 0.039) was observed. Conclusion In successfully thrombolysed STEMI patients receiving dual antiplatelet therapy, there is an inverse correlation between residual thrombus burden and TIMI flow grade with high-grade residual thrombus associated with more frequent low TIMI flow. Further, significant residual stenosis is more common in patients older than 45 years of age, underscoring the necessity for invasive evaluation after successful thrombolysis.
在ST段抬高型心肌梗死（STEMI）患者成功溶栓后，在罪犯血管中可见从微小到巨大的不同程度残留血栓。溶栓患者中与残留血栓相关的因素尚不清楚。我们研究的目的是确定接受双联抗血小板治疗的STEMI成功溶栓患者残留血栓负荷的相关因素。方法：在这项对60例接受双联抗血小板治疗的STEMI成功溶栓患者的前瞻性观察研究中，评估了各种临床和冠状动脉造影特征，如残留血栓负荷、残留狭窄以及梗死相关动脉的心肌梗死溶栓（TIMI）血流分级。结果：60例患者中，分别有49例和11例患者血栓负荷低和高。低级别血栓患者中有37例（75.5%）TIMI血流为3级，而高血栓负荷患者中有7例（63.6%）TIMI血流为2级，表明残留血栓负荷与TIMI血流分级之间存在关联，具有统计学意义（p=0.009）。此外，在39例年龄≥45岁的患者中，观察到年龄与残留狭窄之间存在统计学意义的关联（p = 0.039）。结论：在接受双联抗血小板治疗的STEMI成功溶栓患者中，残留血栓负荷与TIMI血流分级呈负相关，高级别残留血栓与更频繁的低TIMI血流相关。此外，显著的残留狭窄在年龄大于45岁的患者中更常见，这突出了成功溶栓后进行有创评估的必要性。
