Angiographic Stent Thrombosis After Routine Use of Drug-Eluting Stents in ST-Segment Elevation Myocardial InfarctionThe Importance of Thrombus Burden
Georgios Sianos, MD, PhD*,
Michail I. Papafaklis, MD,
Joost Daemen, MD,
Sofia Vaina, MD,
Carlos A. van Mieghem, MD,
Ron T. van Domburg, PhD,
Lampros K. Michalis, MD, MRCP and
Patrick W. Serruys, MD, PhD, FACC
Erasmus Medical Center, Department of Interventional Cardiology, Thoraxcenter, Rotterdam, the Netherlands
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Figure 1 Thrombus Burden Evaluation in a Patient Presenting With an Occluded Infarct-Related Artery
(A) An occluded left anterior descending coronary artery (arrow) after the take-off of the first diagonal branch (D1) in a patient who presented with anterior myocardial infarction. (B) After crossing the occlusion with an angioplasty guidewire (arrowheads) and without further intervention, Thrombolysis In Myocardial Infarction flow grade 1 was restored, allowing the visualization of a large thrombus (arrows).
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Figure 2 Overall Clinical Outcomes
Two-year cumulative mortality, repeat nonfatal myocardial infarction (MI), infarct-related artery lesion repeat revascularization (TLR), infarct-related artery repeat revascularization (TVR), and major adverse cardiac event (MACE) (death, MI, TVR) rates of patients treated with drug-eluting stents.
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Figure 3 Mortality and MACE According to Thrombus Burden
Two-year cumulative mortality and MACE (death, repeat nonfatal myocardial infarction, or infarct-related artery repeat revascularization) rates according to the reclassified thrombus grades before (A, B) and after stratification in large thrombus burden (LTB) and small thrombus burden (STB) (C, D). Other abbreviations as in Figure 2.
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Figure 4 Impact of Thrombus Burden on Mortality
Two-year (A) and post-30-days cumulative mortality (B) according to the presence of large thrombus burden (LTB) or small thrombus burden (STB) at the index procedure.
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Figure 5 Infarct-Related Artery Stent Thrombosis
Two-year cumulative infarct-related artery stent thrombosis (IRA-ST) rate for the total population and according to the existence of large thrombus burden (LTB) or small thrombus burden (STB) at the index procedure.
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Figure 6 Impact of Thrombus Burden and IRA-ST on Repeat MI and TLR
Two-year cumulative (A) repeat myocardial infarction (MI) and (C) infarct-related artery lesion repeat revascularization (TLR) rates in relation to large thrombus burden (LTB) or small thrombus burden (STB) at the index procedure. The corresponding rates after excluding patients with infarct-related artery stent thrombosis (IRA-ST) are presented in (B) and (D), respectively. After excluding IRA-ST, the total 2-year cumulative repeat MI and TLR rates are 3.3% and 1.7%, respectively.
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Figure 7 Impact of Thrombus Burden and IRA-ST on MACE
Two-year cumulative major adverse cardiac event (MACE) rate (A), post-30-days cumulative MACE rate (B), and post-30-days cumulative MACE rate after excluding patients with infarct-related artery stent thrombosis (C) in relation to large thrombus burden (LTB) and small thrombus burden (STB) at the index procedure.
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