The relationship between atria score and coronary thrombus burden in patients with ST segment elevation myocardial infarction

Purpose: The standard treatment for ST segment elevation myocardial infarction (STEMI) is primary percutaneous coronary intervention (PPKG). Although myocardial and epicardial perfusion is usually achieved with PPKG, the thrombus burden of the infarction-related artery (IRA) negatively affects the success of the procedure and clinical outcomes. TIMI (Thrombolysis in myocardial infarction) Thrombus Grade score is one of the commonly used methods for intracoronary thrombus grade. ATRIA score is a valid, practical method used in the risk classification of thromboembolic complications due to atrial fibrillation. ATRIA risk scoring has been developed to estimate the risk of ischemic cerebrovascular events in atrial fibrillation patients who do not receive anticoagulant therapy. In this study, it was aimed to examine the relationship between ATRIA score and TIMI Thrombus grade in patients who presented with STEMI and had percutaneous coronary intervention. Materials and Methods: Our study included 307 patients who were prospectively admitted with STEMI between August 2020 and March 2021. Coronary angiography images of patients with PKG were monitored by two separate cardiologists and calculated based on the TIMI Trombus Grade (TTG) score described by Gibson and his colleagues, of the thrombus burden in the responsible lesion after the lesion was passed by wire or the small balloon was inflated. Patients were divided into two groups as High TTG (grade 4-5) and Low TTG (grade 0-3). Demographic and clinical characteristics of the patients were recorded and ATRIA scoring was performed. The study was designed as a cross-sectional observational prospective study. It was designed in accordance with the Helsinki Declaration and received approval from the local regional ethics committee for the study. Results: In our study 75% (n=230) of patients with Low TTG; 25% (n=77) had High TTG. In the High TTG group, the ATRIA score was significantly higher (p<0,001). In the High TTG group, the rate of DM (p=0.02), HT (p=0.01) smoking (p=0.01), stroke (p=0.01), PAH (p=0.02) was significantly higher. No-reflow and in-hospital mortality rates were significantly higher in the High TTG group (p=0.01). Age (p=0.01), diastolic blood pressure (p=0.02), pulse (p=0.04), ATRIA (p=0.01), SYNTAX (p=0 ,01), CHA2DS2-VASc (p=0.01), and GRACE (p=0.01) scores were significantly higher in the High TTG group (p<0.05). The chest pain duratin, pain balloon time and CAG duration was significantly higher in the High TTG group (p<0.05). CK MB, AST and CRP/Alb measurements were found to be significantly higher in the High TTG group (p<0.05). Conclusion: In this study, it was found that the thrombus burden was associated with ATRIA score in patients presenting with STEMI. Keywords: ATRİA score, thrombus burden, ST segment elevation miocardial infarction