Histopathological Features of Aspirated Thrombi after Primary Percutaneous Coronary Intervention in Patients with ST-Elevation Myocardial Infarction

Abstract

BackgroundPlaque disruption with superimposed thrombus is the predominant mechanism responsible for the onset of acute coronary syndromes. Studies have shown that plaque disruption and thrombotic occlusion are frequently separated in time. We established the histopathological characteristics of material aspirated during primary percutaneous coronary intervention (PCI) in a large consecutive ST-elevation myocardial infarction (STEMI) population.Methodology/Principal FindingsThrombus aspiration during primary PCI was performed in 1,362 STEMI patients. Thrombus age was classified as fresh (<1 day), lytic (1–5 days), or organized (>5 day). Further, the presence of plaque was documented. The histopathological findings were related to the clinical, angiographic, and procedural characteristics. Material could be aspirated in 1,009 patients (74%). Components of plaque were found in 395 of these patients (39%). Fresh thrombus was found in 577 of 959 patients (60%) compared to 382 patients (40%) with lytic or organized thrombi. Distal embolization was present in 21% of patients with lytic thrombus compared to 12% and 15% of patients with fresh or organized thrombus.Conclusions/SignificanceMaterial could be obtained in 74% of STEMI patients treated with thrombus aspiration during primary PCI. In 40% of patients thrombus age is older than 24 h, indicating that plaque disruption and thrombus formation occur significantly earlier than the onset of symptoms in many patients.

Thrombus Aspiration Therapy and Coronary Thrombus Components in Patients with Acute ST-Elevation Myocardial Infarction

“…The results of histopathological evaluations of aspirated intracoronary thrombi obtained from STEMI patients have recently been presented [73][74][75][76][77] . Rittersma et al investigated 199 aspirated intracoronary thrombi obtained from STEMI patients within six hours of symptom onset and pathologically classified them into fresh thrombi (＜1 day old) composed of layered patterns of fibrin and intact platelets, erythrocytes and granulocytes and older thrombi with lytic (1 to 5 days) or organized (＞5 days) changes 73) .…”

Bacterial Signatures in Thrombus Aspirates of Patients With Myocardial Infarction

“…The thrombus itself is erythrocyte rich (red) in 30% to 40% and contains only platelets (white) in 60% to 65% of cases. 48,49 Panoramic tomographies were not available for all of our patients, limiting the statistical power of the analysis, which is reflected in the wide confidence intervals. The results in regard to the associations should therefore be interpreted with caution.…”

Impact of Atherosclerotic Risk Factors on Histopathological Features of Aspirated Coronary Thrombi in St Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention

“…This is consistent with the findings from similar previous studies and confirms the concept that thrombus formation and its subsequent lysis or organisation may occur significantly before the onset of symptoms in acute coronary syndrome especially STEMI. 5,6 The composition of most of the thrombi were heterogenous, showing in part features of fresh, lytic and organised thrombus, thus conceptually supporting the fact that coronary artery disease is a dynamic process. Even though risk stratification in ACS is possible by angiographic grading of thrombus, the most powerful yet simplest method of stratification is based on clinical risk factors.…”