Rationale and design of a prospective, observational study for the QUantitative EStimation of Thrombus burden in patients with ST-Elevation Myocardial Infarction using micro-computed tomography: the QUEST-STEMI trial

Efstratios Karagiannidis, Nikolaos V Konstantinidis, Georgios Sofidis, Evangelia Chatzinikolaou, Georgios Sianos, Efstratios Karagiannidis, Nikolaos V Konstantinidis, Georgios Sofidis, Evangelia Chatzinikolaou, Georgios Sianos

Abstract

Background: Although the presence of thrombus in patients with ST-elevation myocardial infarction (STEMI) has been linked to adverse outcomes, routine thrombus aspiration has not been proven effective. A potential explanation is that these patients should be risk-stratified. Traditional clinical, laboratory and angiographic parameters used in clinical trials have been proven inadequate to classify patients. Aspirated thrombotic material characteristics might be an additional important parameter that has not yet been addressed. In this report, we aim to describe a methodological analysis of thrombus aspirated from coronary arteries during primary PCI using micro-Computed Τomography (micro-CT). These data will be combined with traditional factors to develop a risk-stratification system with high discriminative power for these patients.

Methods: Eighty-seven patients with STEMI undergoing thrombus aspiration in AHEPA University Hospital, Greece, will be enrolled in the study. The first patient was enrolled in June 2018. After being aspirated, thrombi are preserved in formalin and their volume and density are calculated with micro-CT. Micro-CT allows us to create 3D models of thrombi from a series of x-ray projection images. These models are further analyzed to find the volume and density of extracted thrombi and to assess potential differences in their structure. Association of these variables with clinical parameters and angiographic outcomes will be explored.

Discussion: QUEST-STEMI is-to our knowledge-the first study of volumetric coronary thrombus assessment by micro-CT. This method could be used in larger, clinically-oriented trials to help stratify patients with thrombus burden according to their risk for adverse outcomes.

Trial registration: QUEST-STEMI trial ClinicalTrials.gov number: NCT03429608 Date of registration: February 12, 2018. The study was prospectively registered (registered prior to enrollment of the first participant).

Keywords: Interventional cardiology; Micro-computed tomography; ST-elevation myocardial infarction; Thrombus; Thrombus aspiration.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Methodology of the QUEST-STEMI study. a Staining of thrombi with phosphotungstic acid (PTA); b Skyscan 1172 in the Institute of Marine Biology, Biotechnology and Aquaculture Heraklion, Greece; c Samples are placed in a specific vial which contains ethanol; d Samples are mounted on the specific head inside the micro-CT; e-f Representative samples of thrombi. The samples were stained using 0.3% PTA as a contrast agent and scanned using Skyscan 1172 at a voltage of 48 kV and 204μΑ without filtering for a full rotation of 360o. Images were acquired at a pixel size of 5.52 μm with a camera binning of 1 × 1. The projections were reconstructed with the use of the NRecon (Bruker, Kontich, Belgium) software; g Graphical abstract-overview of the methodology of the QUEST-STEMI study

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