ST Segment Elevation Myocardial Infarction Clinical Trial
Official title:
SsST Segment Resolution After Primary Percutaneous Coronary Intervention. A Comparison Between Primary Percutaneous Coronary Intervention With and Without Thrombus Aspiration
To compare the ST segment resolution after primary percutaneous coronary intervention (PPCI) with and without thrombus aspiration in patients with ST segment elevation myocardial infarction as ST segment resolution is the best indicator for the prediction of the outcome and MACE
The idea of an occluding thrombus and its dissolution had been stated since the 1950s.1
Thrombus is present in the infarct‑related artery in 88% of patients undergoing coronary
artery angiography within the first 4 h of acute myocardial infarction (AMI).
The finding of ST segment elevation in a patient presenting with chest pain allows rapid
identification of those who benefit from emergency reperfusion.
Primary percutaneous coronary intervention (PPCI) is now the preferred strategy for emergency
reperfusion in patients presenting with ST elevation myocardial infarction (STEMI).
Thrombus aspiration (TA) might be an effective procedure for reducing distal embolization and
improving microvascular perfusion in ST-segment elevation myocardial infarction (STEMI),
especially in patients with high thrombus burden.
Despite the class III recommendation for routine Thrombus Aspiration use before balloon
angioplasty or stenting. manual Thrombus Aspiration might still remain a useful strategy for
the interventional cardiologist when treating selected patients with significant thrombus
burden during PPCI.
Thrombus grading is classified as:
Grade 0: No angiographic characteristics of thrombus are present. Grade 1: Possible thrombus
is present with a such characteristics as: Reduced contrast density, haziness, irregular
lesion contour Or smooth convex meniscus at the site of total occlusion Suggestive but not
diagnostic of the thrombus.
Grade 2: There is a definite thrombus with greatest dimension <1/2 the vessel diameter.
Grade 3: There is a definite thrombus but with greatest linear dimension>1/2 but <2 vessel
dimension.
Grade 4: There is a definite thrombus but with greatest linear dimension >2 vessel dimension.
Grade 5: There is a total occlusion (unable to assess thrombus burden due to total vessel
occlusion.
The analysis of ST-segment resolution on the electrocardiogram (ECG) consists of a simple
tool, of easy use and low cost, able to document success of the epicardial reperfusion and
tissue reperfusion after primary PCI.
The persistence of ST-segment elevation on the ECG, despite the restoration of a normal
epicardial flow, signifies a poor prognosis; such persistence is known to be associated with
larger infarct size and higher combined rate of severe cardiovascular adverse events.
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