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World J Cardiol. Jun 26, 2014; 6(6): 381-392
Published online Jun 26, 2014. doi: 10.4330/wjc.v6.i6.381
Coronary thrombus in patients undergoing primary PCI for STEMI: Prognostic significance and management
Sabine Vecchio, Elisabetta Varani, Tania Chechi, Marco Balducelli, Giuseppe Vecchi, Matteo Aquilina, Giulia Ricci Lucchi, Alessandro Dal Monte, Massimo Margheri
Sabine Vecchio, Elisabetta Varani, Marco Balducelli, Giuseppe Vecchi, Matteo Aquilina, Giulia Ricci Lucchi, Alessandro Dal Monte, Massimo Margheri, Division of Cardiology, Cardiac Catheterization Laboratory, Santa Maria Delle Croci Hospital, 48121 Ravenna, Italy
Tania Chechi, Division of Cardiology, Santa Maria Annunziata Hospital, 50100 Firenze, Italy
Author contributions: Vecchio S, Varani E, Chechi T and Balducelli M wrote the manuscript; Vecchi G, Aquilina M, Ricci Lucchi G, Dal Monte A and Margheri M revised the manuscript critically for important intellectual content.
Correspondence to: Sabine Vecchio, MD, Division of Cardiology, Cardiac Catheterization Laboratory, Santa Maria Delle Croci Hospital, Viale Randi n°5, 48121 Ravenna, Italy. sabinevecchio@gmail.com
Telephone: +39-0544-285745 Fax: +39-0544-285745
Received: December 7, 2013
Revised: April 3, 2014
Accepted: April 11, 2014
Published online: June 26, 2014
Processing time: 200 Days and 14.9 Hours
Abstract

Acute ST-elevation myocardial infarction (STEMI) usually results from coronary atherosclerotic plaque disruption with superimposed thrombus formation. Detection of coronary thrombi is a poor prognostic indicator, which is mostly proportional to their size and composition. Particularly, intracoronary thrombi impair both epicardial blood flow and myocardial perfusion, by occluding major coronary arteries and causing distal embolization, respectively. Thus, although primary percutaneous coronary intervention is the preferred treatement strategy in STEMI setting, the associated use of adjunctive antithrombotic drugs and/or percutaneous thrombectomy is crucial to optimize therapy of STEMI patients, by improving either angiographical and clinical outcomes. This review article will focus on the prognostic significance of intracoronary thrombi and on current antithrombotic pharmacological and interventional strategies used in the setting of STEMI to manage thrombotic lesions.

Keywords: ST-elevation myocardial infarction; Intracoronary thrombosis; Primary percutaneous coronary intervention; Antithrombotic therapies; Coronary thrombectomy

Core tip: Intracoronary thrombosis, is the basic pathophysiologic event in acute ST-elevation myocardial infarction (STEMI), and thrombi are very frequently detected in STEMI patients undergoing primary percutaneous coronary intervention (PPCI). Thrombus burden and components are important determinants of prognosis in STEMI, being well-known risk factors for long-term adverse cardiovascular events, distal embolization and stent thrombosis. As a result, percutaneous management of lesions with a consistent thrombotic burden is still challenging in the setting of PPCI for STEMI. Therefore, several pharmacological and interventional strategies, such as thrombectomy have been developed in order to improve PPCI’s safety and efficacy, by reducing thrombus burden.