Sex Differences According to Thrombus Burden in STEMI Patients

Many studies have shown there is higher mortality and complications among women after acute myocardial infarction (AMI) vs. men, especially after 30 days. Even though the mechanism driving higher mortality remains uncertain, recent studies have seen differences in thrombus formation with increased platelet count among women.

¿Hay diferencias entre mujeres y hombres luego de una intervención percutánea?

In STEMI patients, intracoronary thrombus burden is a predictor of periprocedural complications and in hospital adverse events. Manual thrombus aspiration has been looked at by many studies, but its prognosis remains unclear. 

Looking at data on thrombus burden (TB) and clinical outcomes of 3 studies on manual thrombus aspiration, the aim of this study was to assess sex related differences and their clinical implications for a large cohort of STEMI patients undergoing primary PCI. 

Primary end point was cardiovascular death at 1 year. Secondary end point included recurrent AMI, cardiac failure, all-cause mortality, stroke or transient ischemic attach, stent thrombosis and target vessel revascularization at 1 year. 

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It included patients from 3 studies: TAPAS (Thrombus Aspiration During Percutaneous Coronary Intervention in Acute Myocardial Infarction Study), TASTE (Thrombus Aspiration in ST Elevation Myocardial Infarction in Scandinavia), and TOTAL (Routine Aspiration Thrombectomy with PCI Versus PCI Alone in Patients with STEMI Undergoing Primary PCI). 

Of a total 18256 patients, 23% were women. Most patients presented high thrombus burden at PCI (defined as TIMI thrombus grade ≥3) and the prevalence of high thrombus burden was lower in women vs. men (p< 0.0001). When comparing against men, women were older, more frequently presented high blood pressure and higher ischemia time. On the other hand, they had less prior AMI and PCI.  

Patients with high thrombus burden had worse results at one year vs. patients with low thrombus burden (p=0.01).

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Women had significantly higher risk of cardiovascular and all-cause mortality, stroke or transient ischemic attack and cardiac failure. Looking at results according to thrombus burden, there were no differences in risk of cardiovascular mortality among men and women with low TB, while among patients with high TB, women presented higher risk of cardiovascular mortality. This difference was more pronounced during the first 30 days after PCI. Also, women with high TB had higher risk of all-cause mortality, stent thrombosis and cardiac failure. 

Conclusion

In STEMI patients, the presence of high thrombus burden has a negative impact on prognosis. In addition, women with high thrombus burden had higher risk of cardiovascular mortality at 1 year vs men. Thrombus burden stratification should be considered when making decisions about these patients, who will benefit from more aggressive treatment. 

Dr. Andrés Rodríguez.
Member of the Editorial Board of SOLACI.org.

Original Title: Sex-Related Differences in Thrombus Burden in STEMI Patients Undergoing Primary Percutaneous Coronary Intervention.

Reference: Maria Virginia Manzi, MD et al Am Coll Cardiol Intv 2022;15:2066–2076.


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