Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands.
Amphia Hospital, Breda, The Netherlands.
J Thromb Thrombolysis. 2022 Jul;54(1):47-57. doi: 10.1007/s11239-021-02603-3. Epub 2021 Nov 26.
Large thrombus burden (LTB) during ST-segment elevation myocardial infarction (STEMI) could translate into worse clinical outcomes. The impact of a LTB in terms of long-term clinical outcomes on different myocardial infarct territories has not yet been fully evaluated. From April 2002 to December 2004, consecutive patients with STEMI undergoing percutaneous coronary intervention with drug eluting stent were evaluated. The study sample was stratified in two groups: anterior STEMI and non-anterior STEMI. LTB was considered as a thrombus larger than or equal to 2-vessel diameters, and small thrombus burden less than 2-vessel diameters. Major adverse cardiac events (MACE) were evaluated at 10-year and survival data were collected up to 15-year. A total of 812 patients were evaluated, 6 patients were excluded due to inadequate angiographic images, 410 (50.9%) had an anterior STEMI and 396 (49.1%) a non-anterior STEMI. Patients with LTB had higher rates of 10-year mortality (aHR 2.27, 95%CI 1.42-3.63; p = 0.001) and 10-year MACE (aHR 1.46, 95%CI 1.03-2.08; p = 0.033) in anterior STEMI, but not in non-anterior STEMI (aHR 0.78, 95%CI 0.49-1.24; p = 0.298; aHR 0.71, 95%CI 0.50-1.02; p = 0.062). LTB was associated with increased 30-day mortality (aHR 5.60, 95%CI 2.49-12.61; p < 0.001) and 30-day MACE (aHR 2.72, 95%CI 1.45-5.08; p = 0.002) in anterior STEMI, but not in non-anterior STEMI (aHR 0.39, 95%CI 0.15-1.06; p = 0.066; aHR 0.67, 95%CI 0.31-1.46; p = 0.316). Beyond 30-day, LTB had no impact on mortality and MACE in both groups. In anterior STEMI, LTB is associated with worse long-term clinical outcomes, this effect was driven by early events.
大面积血栓负荷（LTB）与 ST 段抬高型心肌梗死（STEMI）患者的临床预后较差有关。然而，LTB 在不同心肌梗死部位对长期临床结局的影响尚未得到充分评估。本研究纳入了 2002 年 4 月至 2004 年 12 月间接受药物洗脱支架经皮冠状动脉介入治疗的连续 STEMI 患者。研究样本分为两组：前壁 STEMI 和非前壁 STEMI。LTB 定义为血栓大于或等于 2 个血管直径，小血栓负荷小于 2 个血管直径。主要不良心脏事件（MACE）在 10 年时进行评估，并收集了长达 15 年的生存数据。共评估了 812 例患者，其中 6 例因造影图像不足而被排除，410 例（50.9%）为前壁 STEMI，396 例（49.1%）为非前壁 STEMI。LTB 患者在前壁 STEMI 中 10 年死亡率（校正 HR 2.27，95%CI 1.42-3.63；p=0.001）和 10 年 MACE（校正 HR 1.46，95%CI 1.03-2.08；p=0.033）发生率更高，但在非前壁 STEMI 中则没有（校正 HR 0.78，95%CI 0.49-1.24；p=0.298；校正 HR 0.71，95%CI 0.50-1.02；p=0.062）。LTB 与前壁 STEMI 患者 30 天死亡率（校正 HR 5.60，95%CI 2.49-12.61；p<0.001）和 30 天 MACE（校正 HR 2.72，95%CI 1.45-5.08；p=0.002）的增加相关，但与非前壁 STEMI 无关（校正 HR 0.39，95%CI 0.15-1.06；p=0.066；校正 HR 0.67，95%CI 0.31-1.46；p=0.316）。30 天后，LTB 对两组的死亡率和 MACE 均无影响。在前壁 STEMI 中，LTB 与较差的长期临床结局相关，这种影响是由早期事件驱动的。
