scholarly journals Adjunctive Catheter-Directed Thrombolysis during Primary PCI for ST-Segment Elevation Myocardial Infarction with High Thrombus Burden

2022 ◽  
Vol 11 (1) ◽  
pp. 262
Author(s):  
Satsuki Noma ◽  
Hideki Miyachi ◽  
Isamu Fukuizumi ◽  
Junya Matsuda ◽  
Hideto Sangen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Aspiration Thrombectomy ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Catheter Directed Thrombolysis ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Significant Difference

Background: High coronary thrombus burden has been associated with unfavorable outcomes in patients with ST-segment elevation myocardial infarction (STEMI), the optimal management of which has not yet been established. Methods: We assessed the adjunctive catheter-directed thrombolysis (CDT) during primary percutaneous coronary intervention (PCI) in patients with STEMI and high thrombus burden. CDT was defined as intracoronary infusion of tissue plasminogen activator (t-PA; monteplase). Results: Among the 1849 consecutive patients with STEMI, 263 had high thrombus burden. Moreover, 41 patients received t-PA (CDT group), whereas 222 did not receive it (non-CDT group). No significant differences in bleeding complications and in-hospital and long-term mortalities were observed (9.8% vs. 7.2%, p = 0.53; 7.3% vs. 2.3%, p = 0.11; and 12.6% vs. 17.5%, p = 0.84, CDT vs. non-CDT). In patients who underwent antecedent aspiration thrombectomy during PCI (75.6% CDT group and 87.4% non-CDT group), thrombolysis in myocardial infarction grade 2 or 3 flow rate after thrombectomy was significantly lower in the CDT group than in the non-CDT group (32.2% vs. 61.0%, p < 0.01). However, the final rates improved without significant difference (90.3% vs. 97.4%, p = 0.14). Conclusions: Adjunctive CDT appears to be tolerated and feasible for high thrombus burden. Particularly, it may be an option in cases with failed aspiration thrombectomy.

scholarly journals Safety and Efficacy of Adjunctive Catheter-Directed Thrombolysis During Primary PCI for ST-segment Elevation Myocardial Infarction With High Thrombus Burden

2021 ◽  
Author(s):  
Satsuki Noma ◽  
Hideki Miyachi ◽  
Isamu Fukuizumi ◽  
Junya Matsuda ◽  
Hideto Sangen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Flow ◽  
Bleeding Complications ◽  
Primary Pci ◽  
Aspiration Thrombectomy ◽  
Safety And Efficacy ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Catheter Directed Thrombolysis ◽  
St Segment

Background: High coronary thrombus burden has been associated with unfavorable outcomes in patients with ST-segment elevation myocardial infarction (STEMI), the optimal management of which has not yet to be established. Methods: We evaluated the safety and efficacy of adjunctive catheter-directed thrombolysis (CDT) during primary percutaneous coronary intervention (PCI) in patients with STEMI and high thrombus burden. Results: Among the 1,849 consecutive patients with STEMI, 263 had high thrombus burden. Moreover, 41 patients received intracoronary infusion of tissue plasminogen activator during primary PCI (CDT group), whereas 222 did not receive (non-CDT group). No significant differences in bleeding complications and in-hospital and long-term mortalities were observed (9.8% vs. 7.2%, p=0.53; 7.3% vs. 2.3%, p=0.11; and 12.6% vs. 17.5%, p=0.84, CDT vs. non-CDT). In patients who underwent antecedent aspiration thrombectomy during PCI (75.6%; CDT group and 87.4%; non-CDT group), thrombolysis in myocardial infarction grade 2 or 3 flow rate after thrombectomy was significantly lower in the CDT group than in the non-CDT group (32.2% vs. 61.0%, p&amp;lt;0.01). However, the final rates improved considerably without significant difference (90.3% vs. 97.4%, p=0.14). Conclusions: For STEMI patients with high thrombus burden, adjunctive CDT is safe and effective for improving coronary flow. CDT resulted in favorable coronary flow even after unsatisfactory aspiration thrombectomy.

Comparison of the clinical characteristics of myocardial infarction with and without ST-segment elevation in Hungary. National Registry of Myocardial Infarction

2014 ◽  
Vol 155 (21) ◽  
pp. 828-832
Author(s):  
Tamás Breuer ◽  
András Jánosi ◽  
Krisztina Szüts ◽  
Péter Andréka ◽  
Péter Ofner
Keyword(s):  
Myocardial Infarction ◽  
Clinical Characteristics ◽  
Coronary Intervention ◽  
National Registry ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
Patient Groups

Introduction: Afew data have been published on the clinical characteristics of different types of myocardial infarction in Hungary. Aim: To compare clinical data of patients with ST-segment elevation and non-ST-segment elevation myocardial infarction based on the National Myocardial Infarction Registry database. Method: Data recorded in the National Myocardial Infarction Registry between January 1, 2010 and June 30, 2012 were included in the analysis. Results: Patients treated with non-ST-segment elevation myocardial infarction (n = 5237) were older and had more comorbidities compared to those with ST-segment elevation myocardial infarction (n = 6670). Coronarography and percutaneous coronary intervention were performed more frequently in the latter group. There was no significant difference in in-hospital mortality between the two groups (5.3% and 4.9%). Medication for secondary prevention after myocardial infarction was applied in nearly 90% of the patients in both groups. Dual antiplatelet therapy was more often applied after ST-segment elevation myocardial infarction. Conclusions: The study confirmed important differences in the clinical characteristics and similar hospital prognosis between the two patient groups. Orv. Hetil., 2014, 155(21), 828–832.

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