Histopathology of aspirated thrombus and its association with ST‐segment recovery in patients undergoing primary percutaneous coronary intervention with routine thrombus aspiration

Verouden, Niels; Kramer, Miranda C.A.; Li, Xiaofei; Meuwissen, Martijn; Koch, Karel T.; Henriques, José P.S.; Baan, Jan; Vis, Marije M.; Piek, Jan J.; Wal, Allard C. van der; Tijssen, Jan G.P.; Winter, Robbert J. de

doi:10.1002/ccd.22616

Cited by 25 publications

(12 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…12 In yet another other study Verouden et al attempted establishing the clinicopathological relationship of the thrombus by electrocardiography and showed that incomplete recovery of the ST-segment and the presence of old thrombi were a strong predictor of long-term mortality, irrespective of the histopathology of the thrombus. 15 In the present study more than three fourth patients had symptoms onset within 6 hours of their treatment. However, the organized or lysed thrombi (aged thrombi) are a significantly (p = 0.001) higher in number.…”

Section: Discussionsupporting

confidence: 46%

Can ischemic time predict the age of thrombus in ST elevation myocardial infarction?: an analysis from tertiary healthcare center in South India

et al. 2016

View full text Add to dashboard Cite

INTRODUCTIONAcute ST-elevation myocardial infarction (STEMI) is characterized by thrombotic total occlusion of a coronary artery following coronary atherosclerotic plaque disruption.1 Initial stages of coronary artery stenosis when the plaque disruptions are covered by mural thrombi, mostly remain asymptomatic. Over the time, ABSTRACTBackground: ST Elevation myocardial infarction (STEMI) is characterized by plaque disruption with superimposed thrombus formation. However, studies from western population have suggested a delay between plaque disruption and the onset of symptoms. There is a paucity of Indian data on the relationship between ischemic time and the age of thrombus. Hence, we decided to study the histopathological characteristics of thrombus aspirated during primary percutaneous coronary intervention (PPCI) in patients of STEMI and its relation with the ischemic time. Methods: 107 consecutive patients of STEMI undergoing PPCI with thrombus aspiration, mostly within 12 hours of symptom onset were included in this study. The aspirated thrombi were fixed in 10% formalin, processed and analysed by light microscopy. The thrombi were categorized as recent or lysed according to the histopathological characteristics. Results: The mean age of the study population was 54.93 13.19 years. There were males 94 (87.85%) and 13(12.15%) were females. The culprit vessel was LAD in 36 (32.73%), RCA in 57 (51.82%) and LCX in 13 (11.82%). Left Main, Diagonal and OM were culprit vessels in one case (0.91%) each. Thrombus was identified in 102 (95.3%) out of 107 patients where as in five patients (4.7%) only plaque was seen. Histopathology revealed lysed thrombus in 68 (66.7%) of 102 patients, and recent thrombus in 34 (33.3%) patients. Conclusions: In patients with STEMI, undergoing PPCI within 12 hours of symptom onset, majority of the thrombi were lysed indicative of a thrombus age of at least 24 hours. This suggests that plaque instability and thrombus formation frequently precedes the onset of symptoms. Hence, ischemic time cannot predict the age of thrombus in STEMI.

show abstract

Section: Discussionsupporting

confidence: 46%

Can ischemic time predict the age of thrombus in ST elevation myocardial infarction?: an analysis from tertiary healthcare center in South India

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Moreover, MPO-positive cells, constituted by neutrophils and only occasionally by macrophages [35] , and erithrocyte-rich thrombi were shown to be associated with impaired coronary microcirculation, as assessed by ST-segment resolution and myocardial blush grade after PPCI in STEMI patients [36,37] . Finally, independently from the histopathology of aspirated thrombi, patients with fresh thrombus tended to have better STsegment resolution than patients with older thrombus [38] . Prediction of thrombus burden and composition, as well as plaque volume and composition, before the procedure in patients with STEMI undergoing PPCI, may contribute to optimize percutaneous treatment of these highly thrombotic lesions, guiding utilization of pharmacological agents or interventional strategies, in order to reduce thrombus burden and improve both epicardial and myocardial perfusion.…”

Section: Prognostic Significance Of Angiographically Detected Coronarmentioning

confidence: 90%

Coronary thrombus in patients undergoing primary PCI for STEMI: Prognostic significance and management

Vecchio¹

2014

WJC

View full text Add to dashboard Cite

Acute ST-elevation myocardial infarction (STEMI) usually results from coronary atherosclerotic plaque disruption with superimposed thrombus formation. Detection of coronary thrombi is a poor prognostic indicator, which is mostly proportional to their size and composition. Particularly, intracoronary thrombi impair both epicardial blood flow and myocardial perfusion, by occluding major coronary arteries and causing distal embolization, respectively. Thus, although primary percutaneous coronary intervention is the preferred treatement strategy in STEMI setting, the associated use of adjunctive antithrombotic drugs and/or percutaneous thrombectomy is crucial to optimize therapy of STEMI patients, by improving either angiographical and clinical outcomes. This review article will focus on the prognostic significance of intracoronary thrombi and on current antithrombotic pharmacological and interventional strategies used in the setting of STEMI to manage thrombotic lesions.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words: ST-elevation myocardial infarction; Intracoronary thrombosis; Primary percutaneous coronary intervention; Antithrombotic therapies; Coronary thrombectomyCore tip: Intracoronary thrombosis, is the basic pathophysiologic event in acute ST-elevation myocardial infarction (STEMI), and thrombi are very frequently detected in STEMI patients undergoing primary percutaneous coronary intervention (PPCI). Thrombus burden and components are important determinants of prognosis in STEMI, being well-known risk factors for longterm adverse cardiovascular events, distal embolization and stent thrombosis. As a result, percutaneous management of lesions with a consistent thrombotic burden is still challenging in the setting of PPCI for STEMI. Therefore, several pharmacological and interventional strategies, such as thrombectomy have been developed in order to improve PPCI's safety and efficacy, by reducing thrombus burden.

show abstract

“…Several retrospective studies have suggested that older thrombus, including organized thrombus, is associated with not only ST-segment recovery but also distal embolization, and that the presence of older thrombus is an independent predictor of long-term mortality in patients with STEMI who undergo primary PCI with thrombus aspiration. 5- 7 We prospectively dem- 24 However, the prevalence of calcification in aspirated coronary material has remained unknown. We found that calcified deposition in 17% of the patients was not related to in-hospital death.…”

Section: Discussionmentioning

confidence: 99%

Organized Thrombus in Aspirated Coronary Materials Can Predict In-Hospital Mortality of Patients With Acute Myocardial Infarction

Nishihira

Hatakeyama

Shibata

et al. 2013

Circ J

View full text Add to dashboard Cite

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp associated the histopathology of aspirated thrombus with myocardial reperfusion, ST-segment recovery and distal embolization in patients with STEMI. 6-8 These lines of evidence indicate that the histopathology of aspirated coronary material is associated with in-hospital mortality. However, this notion has received scant attention. We therefore investigated the histopathologic features of material (ie, organized thrombus, calcification and of plaque component) aspirated during primary PCI from patients with AMI, and assessed whether the histological findings were associated with in-hospital mortality. Editorial p 1152 Methods Study PopulationThis prospective single-center registry included 310 consecuhrombus propagation on disrupted atherosclerotic plaque leads to acute myocardial infarction (AMI). To prevent the distal embolization of atherothrombotic material, thrombus aspiration in the setting of primary percutaneous coronary intervention (PCI) is the preferred reperfusion therapy for AMI, as it improves myocardial reperfusion, left ventricular functional recovery and clinical outcomes compared with conventional PCI. 1-3 This technique enables fresh specimens of the coronary thrombi causing AMI to be obtained from patients during the acute phase of AMI. 1,4-8 Several recent pathologic assessments of aspirated material have suggested that plaque rupture and sudden coronary occlusion are often preceded by a variable period of plaque instability and thrombus formation, and that the presence of older thrombus is an independent predictor of long-term mortality in patients with ST-elevation myocardial infarction (STEMI) treated with thrombus aspiration during primary PCI. Recent studies have shown that the histopathology of the coronary thrombus is associated with myocardial reperfusion, ST-segment recovery, distal embolization and long-term mortality in patients with AMI. Therefore, we investigated the histopathologic characteristics of material aspirated during percutaneous coronary intervention (PCI) in patients with AMI, and assessed whether the histologic findings are related to in-hospital mortality.

show abstract

Histopathology of aspirated thrombus and its association with ST‐segment recovery in patients undergoing primary percutaneous coronary intervention with routine thrombus aspiration

Cited by 25 publications

References 45 publications

Can ischemic time predict the age of thrombus in ST elevation myocardial infarction?: an analysis from tertiary healthcare center in South India

Can ischemic time predict the age of thrombus in ST elevation myocardial infarction?: an analysis from tertiary healthcare center in South India

Coronary thrombus in patients undergoing primary PCI for STEMI: Prognostic significance and management

Organized Thrombus in Aspirated Coronary Materials Can Predict In-Hospital Mortality of Patients With Acute Myocardial Infarction

Contact Info

Product

Resources

About