Background

ST-segment elevation myocardial infarction (STEMI) is primarily caused by acute thrombotic occlusion of a coronary artery following plaque rupture or plaque erosion. Coronary thrombus burden is a critical determinant of myocardial perfusion, procedural success during primary percutaneous coronary intervention (PPCI), and long-term cardiovascular outcomes. Despite advances in antithrombotic therapies and interventional techniques, patients with high thrombus burden remain at increased risk of distal embolization, no-reflow phenomenon, recurrent ischemic events, heart failure, and mortality.

Objective

To evaluate the impact of coronary thrombus burden on clinical outcomes in STEMI patients undergoing primary PCI and review contemporary strategies for assessment and management.

Methods

A comprehensive review of randomized trials, observational registries, angiographic studies, and guideline-based evidence was performed. The relationship between thrombus burden and procedural as well as long-term clinical outcomes was examined.

Results

High thrombus burden is strongly associated with impaired coronary flow, distal embolization, larger infarct size, no-reflow, reduced left ventricular function, increased major adverse cardiovascular events (MACE), and higher mortality. Advanced imaging techniques and optimized pharmacological and interventional approaches improve outcomes in selected patients.

Conclusion

Coronary thrombus burden remains a major prognostic marker in STEMI. Early identification and individualized management strategies are essential for improving myocardial reperfusion and reducing adverse cardiovascular outcomes.