The impact of initial and residual thrombus burden on the no-reflow phenomenon in patients with ST-segment elevation myocardial infarction

• Published in: Coronary artery disease Vol. 26; no. 3; p. 245
• Main Authors: Ahn, Sung Gyun, Choi, Hyun-Hee, Lee, Ji Hyun, Lee, Jun-Won, Youn, Young Jin, Yoo, Sang-Yong, Cho, Byung Ryul, Lee, Seung-Hwan, Yoon, Junghan
• Format: Journal Article
• Language: English
• Published: England 01.05.2015
• Subjects: Aged; Chi-Square Distribution; Coronary Angiography; Coronary Circulation; Coronary Thrombosis - complications; Coronary Thrombosis - diagnosis; Coronary Thrombosis - physiopathology; Coronary Thrombosis - therapy; Drug-Eluting Stents; Female; Humans; Kaplan-Meier Estimate; Logistic Models; Male; Middle Aged; Myocardial Infarction - diagnosis; Myocardial Infarction - etiology; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; No-Reflow Phenomenon - diagnosis; No-Reflow Phenomenon - etiology; No-Reflow Phenomenon - physiopathology; No-Reflow Phenomenon - prevention & control; Odds Ratio; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - instrumentation; Randomized Controlled Trials as Topic; Retrospective Studies; Risk Factors; Thrombectomy - adverse effects; Thrombectomy - methods; Time Factors; Treatment Outcome
• ISSN: 1473-5830
• DOI: 10.1097/MCA.0000000000000197

Limited data are available on the clinical significance of residual thrombi after thrombectomy and prestenting reduced epicardial coronary flow in ST-segment elevation myocardial infarct (STEMI) patients. The incidence of the no-reflow phenomenon, defined as a final thrombolysis in myocardial infarction (TIMI) flow grade of up to 2 or a myocardial blush grade of up to 1, was compared in 260 STEMI patients undergoing primary percutaneous coronary intervention according to thrombotic burden. Large thrombotic burden (LTB), defined as a thrombus score of at least 3, was observed in 134 patients, among whom 66 (49.3%) underwent aspiration thrombectomy. No-reflow incidence was compared on the basis of thrombectomy treatment, thrombus residue after thrombectomy, and prestenting TIMI flow grade. The no-reflow phenomenon occurred most frequently in LTB patients without thrombectomy, followed by those who underwent thrombectomy and the small thrombus burden group (33.8 vs. 21.2 vs. 10.3%, respectively, P<0.001). Patients with a prestenting residual thrombus or a TIMI flow grade of up to 2 had higher no-reflow incidence than those with no visible prestenting thrombus and a TIMI flow grade of 3 (74 vs. 6.2%, P<0.001). Multiple logistic regression analysis identified a prestenting TIMI flow grade of up to 2 (odds ratio 36.422, 95% confidence interval 13.952-95.079) as an independent predictor of the no-reflow phenomenon. Manual thrombus aspiration reduced no-reflow incidence in STEMI patients with LTB. However, even after thrombectomy, prestenting residual thrombi and decreased coronary flow were related to a higher occurrence of the no-reflow phenomenon.