Interventional Cardiology, Thoraxcenter, Erasmus MC, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
J Invasive Cardiol. 2021 Nov;33(11):E900-E909. doi: 10.25270/jic/20.00654.
The impact of large thrombus burden (LTB) on very long-term clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) is unknown. We compared very long-term clinical outcomes in STEMI patients with either LTB or small thrombus burden (STB).
Between 2002 and 2004, thrombus burden (TB) was evaluated in consecutive patients with STEMI undergoing percutaneous coronary intervention (PCI). In occluded infarct-related arteries, TB was reclassified after flow restoration. LTB was defined as thrombus ≥2 vessel diameters. Major adverse cardiac event (MACE) rate was evaluated at 10-year follow-up and survival data were collected up to 15 years post PCI.
A total of 812 patients were enrolled, and TB assessment was available for 806 patients (99.3%); 580 patients (72.0%) had STB and 226 patients (28.0%) had LTB. Patients with LTB experienced more no reflow (4.0% vs 0.5%; P<.01) and distal embolization (17.3% vs 3.4%; P<.001) than STB patients. Ten-year MACE rate (42.5% vs 42.4%; P=.59), 10-year mortality rate (27.0% vs 26.4%; P=.75), and 15-year mortality rate (31.9% vs 35.9%; P=.29) were similar between STB and LTB groups, respectively. By landmark analysis, MACE rate was higher in the LTB group (15.9% vs 8.8%; P<.01) at 30 days, but not beyond (31.6% vs 36.9%; P=.28). There was no difference in mortality at any time point (at 30 days, 9.7% vs 6.2%; P=.08; beyond 30 days, 17.3% vs 20.5%; P=.48). LTB was an independent predictor of MACE at 30 days post PCI (hazard ratio, 1.60; 95% confidence interval, 1.01-2.51; P=.04).
In STEMI patients, LTB might identify a subpopulation at high risk of no-reflow, distal embolization, and early ischemic events, but is not associated with worse clinical outcomes at long-term follow-up.
目前尚不清楚大血栓负荷（LTB）对 ST 段抬高型心肌梗死（STEMI）患者的长期临床结局的影响。我们比较了 LTB 与小血栓负荷（STB）的 STEMI 患者的长期临床结局。
在 2002 年至 2004 年期间，对接受经皮冠状动脉介入治疗（PCI）的连续 STEMI 患者进行血栓负荷（TB）评估。在闭塞相关动脉中，在血流恢复后重新分类 TB。LTB 定义为血栓≥2 个血管直径。在 10 年随访时评估主要不良心脏事件（MACE）发生率，并在 PCI 后最长 15 年收集生存数据。
共纳入 812 例患者，806 例（99.3%）患者可进行 TB 评估；580 例（72.0%）患者为 STB，226 例（28.0%）患者为 LTB。LTB 患者的无复流（4.0%比 0.5%；P<.01）和远端栓塞（17.3%比 3.4%；P<.001）的发生率更高。STB 和 LTB 患者的 10 年 MACE 发生率（42.5%比 42.4%；P=.59）、10 年死亡率（27.0%比 26.4%；P=.75）和 15 年死亡率（31.9%比 35.9%；P=.29）相似。通过 landmark 分析，LTB 组在 30 天时的 MACE 发生率更高（15.9%比 8.8%；P<.01），但此后无差异（31.6%比 36.9%；P=.28）。在任何时间点，死亡率均无差异（30 天内，9.7%比 6.2%；P=.08；30 天后，17.3%比 20.5%；P=.48）。LTB 是 PCI 后 30 天 MACE 的独立预测因素（风险比，1.60；95%置信区间，1.01-2.51；P=.04）。
在 STEMI 患者中，LTB 可能会识别出无复流、远端栓塞和早期缺血事件风险较高的亚群，但与长期随访时的不良临床结局无关。
