Organized thrombus, disorganized heart.

(59% vs. 38%), which does not reach statistical significance for the small number of patients analyzed. In addition, this higher rate of slow flow could have provoked larger MI, as indirectly reflected by the higher rate of cardiogenic shock and higher level of troponin T in the group of patients who died. It is of note that left ventricular ejection fraction (LVEF) is not mentioned, although it is a known independent predictor of cardiac death post-acute coronary syndrome.7 Another important limitation is the lack of IIb/IIIa use. Although this is unfortunately not approved for use in Japan, it is well known how the combined use of thrombectomy with abciximab is able to improve not only the coronary flow at the end of the primary PCI, but also the LVEF and the incidence of major cardiac adverse events.8 The lack of IIb/IIIa inhibitor therapy seems to be compensated by a relatively high use of thrombolysis therapy during PCI, which could affect the rate of organized thrombus and was higher in those patients who survived as compared with those who died (20% vs. 6%), although statistical significance is again not reached because of the small sample size. With regards to the thrombus characteristics, Kramer et al have already shown an association between thrombus age and survival at 3 years after acute MI (AMI), as well as distal he study of Nishihira et al in this issue of the Journal analyzes the thrombus composition of a population of 264 patients admitted with ST-segment elevation myocardial infarction (STEMI), referred for primary percutaneous coronary intervention (PCI) within the first 24 h.1 The authors found that age, previous myocardial infarction (MI), cardiogenic shock and organized thrombus were independent predictors of in-hospital death. Some of these factors have been already related to ominous in-hospital prognosis and recurrence of MI.2–5