Background Potent antithrombotic medications reduce thrombosis in STEMI but also increase bleeding. Identification of high-risk patients could allow personalised treatment with potent medications, with less potent agents in others to reduce bleeding.

Methods Blood samples from 150 patients with STEMI were assessed pre-PPCI, at discharge and at 30 days using the point-of-care Global Thrombosis Test and related to ECG, angiographic findings and major adverse cardiac events (MACE). The time to form occlusive thrombus under high shear (occlusion time, OT) and the time to dissolve this thrombus through endogenous thrombolysis (lysis time, LT) were assessed.

Results Impaired endogenous thrombolysis (prolonged LT≥3000s), seen in 9% of patients, was associated with persistent ST-elevation, TIMI-0/1 flow pre-PPCI and MACE (Figure 1). Enhanced endogenous thrombolysis (LT 1040s, IQR 940–1105), seen in 17% of patients, was associated with spontaneous ST-resolution, TIMI-2/3 flow pre-PPCI and no adverse events. OT pre-PPCI was shorter in those with MACE than those without (244 ± 130s vs. 414 ± 183s, p = 0.02).

Conclusions Impaired endogenous thrombolysis is associated with reduced coronary flow and adverse events, whilst enhanced thrombolysis with spontaneous reperfusion and favourable outcomes. This could help personalise antithrombotic therapy to reduce adverse events and avoid bleeding.

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Abstract 8 Figure 1

Kaplan-Meier survival curves showing that Lysis Time (LT) was related to MACE at 30 days (HR 3.26, 95% CI: 2.32–29.19, p = 0.004), driven by cardiovascular death (HR 3.12, 95% CI: 3.82–35.23, p < 0.001)