![]() Impact of Thrombus on Percutaneous Coronary Intervention and Clinical Outcome Steps to follow include consideration of the various strategies for managing a thrombus, then to adopt the appropriate strategy and algorithm based on the perceived significance of the thrombus and its response to an individual strategy. The first step is to assess the potential impact of the thrombus on PCI and clinical outcome. Interventionists can take inspiration from the ancient wisdom to fight the enemy. 2Ĭlot is often the enemy during primary percutaneous coronary intervention (PCI). The Art of War, an ancient military treatise composed around the 5th century BCE, stressed the importance of knowing the enemy to adopt different strategies when fighting the enemy, to attack, to surround, to avoid, to battle, to flee. “ If you know the enemy and know yourself, your victory will not stand in doubt.” 1 The key remains to adopt different strategies selectively and appropriately in different scenarios. Of note, most of these strategies have not been demonstrated to be beneficial on routine use. This is to be followed by choosing the appropriate strategy: to attack – aspiration and mechanical thrombectomy to surround – pharmacological therapy, including oral and parenteral antiplatelet therapy and intracoronary thrombolytic therapy to avoid – stenting strategies including direct stenting and deferred stenting to battle – stenting under a distal protection device or stenting across local obstructive thrombus or to flee – to move from percutaneous coronary intervention to optimal antithrombotic therapy and circulatory support when flow fails to be regained. assess the thrombus burden, by both Thrombolysis in MI thrombus grade and angiographic features. Taking inspiration from the ancient wisdom of fighting a war, an interventionist should first look into the strength of the enemy, i.e. In hospitalized NSTEMI patients with high risk of clinical events, early PCI is associated with improved 28-day survival.Ĭoronary delayed early percutaneous revascularization.Clot is often the enemy during primary percutaneous coronary intervention. By 1-year of follow up, there was no significant difference in mortality with respect to early vs. After accounting for potential confounders, early PCI was associated with a 58% reduced 28-day mortality (OR = 0.42 95% CI: 0.21-0.84) for the entire population, and 57% reduced mortality (OR = 0.43 95% CI: 0.21-0.88) for high risk patients. The 28-day and 1-year mortality were 2% and 5%, respectively. Most were white (79%), male (68%), with mean age 61 years. Associations between early versus late PCI and mortality were analyzed using multivariable logistic regression adjusted for demographics, hospitalization year, TIMI score, and comorbidities.įrom 1987 to 2012, 6,746 patients were hospitalized with NSTEMI and underwent PCI. Patients were stratified into low (TIMI score 2-4), and high risk (TIMI score 5-7, or presence of cardiogenic shock, ventricular fibrillation, or cardiac arrest). We limited our study to patients undergoing early (<24 hr of the event onset), or late (≥24 hr) percutaneous coronary intervention (PCI). NSTEMI was classified using a validated algorithm. The ARIC Study has conducted hospital surveillance of acute myocardial infarction (MI) since 1987. The real-world effectiveness of this strategy is unknown. A delayed invasive strategy (24-72 hr) is considered reasonable for low risk patients. Current guidelines recommend early invasive intervention (<24 hr) for high risk patients with non-ST-segment elevation myocardial infarction (NSTEMI). ![]()
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