Angiographic Quantification of Thrombus in ST-Elevation Acute Myocardial Infarction Presenting with an Occluded Infarct-Related Artery and Its Relationship with Results of Percutaneous Intervention

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Routine thrombectomy has been advocated for ST-segment-elevation myocardial infarction (STEMI), but it is unknown how many patients present with a large thrombus. We aimed to quantify the intracoronary thrombus in STEMI and to correlate it with procedure results.


In 98 patients with STEMI and TIMI flow grades 0–2 in the infarct-related artery, thrombus was qualified as small (ST) when its maximal dimension was <2 vessel diameters and large (LT) when ≥2. Main outcome measures were TIMI flow, myocardial blush grade (MBG), corrected TIMI frame count (cTFC), and ST-segment elevation resolution (STSER).


Only a third of the patients presented with an LT. Thrombus grade was independent of the initial vessel patency. Diabetes (OR 3.1, 95% CI 1.20–8.02, P = 0.027) and pretreatment with clopidogrel (OR 0.27, 95% CI 0.08–0.86, P = 0.034) were independent predictors of LT. LT was an independent predictor of unfavorable results: <3 TIMI flow (OR 2.87, 95% CI 1.04–8.00, P = 0.043), MBG 0–1 (OR 3.36, 95% CI 1.10–10.26, P = 0.033), cTFC > 21 (OR 2.86, 95% CI 1.09–7.49, P = 0.033) and <50% STSER (OR 3.19, 95% CI 1.06–9.63, P = 0.039).


Only a third of STEMI patients present with an LT, being diabetes and lack of clopidogrel pretreatment independent predictors. An LT is strongly associated with worse PCI results. (J Interven Cardiol 2009;22:207–215)

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