Plaque Instability Frequently Occurs Days or Weeks Before Occlusive Coronary Thrombosis

Abstract

Background-Acute ST-elevation myocardial infarction (STEMI) is caused by sudden occlusive coronary thrombosis, after plaque disruption; however, a considerable time interval between plaque disturbance and the onset of symptoms has been suggested. We therefore studied the age of intracoronary thrombi, aspirated during angioplasty in patients with acute STEMI. Methods and Results-Percutaneous intracoronary thrombectomy during angioplasty was performed in 211 consecutive STEMI patients within 6 hours after onset of anginal symptoms. The aspirated material was histologically screened on thrombus and plaque components, and thrombus age was classified as fresh (Ͻ1 day), lytic thrombus (1 to 5 days), and organized thrombus (Ͼ5 days). In all patients, intracoronary-derived material was retrieved in the filter of the collection bottle. Thrombus was identified in 199 (95%) of 211 patients. In 12 patients (5%), only plaque components were identified, and in 85 patients (41%), both thrombus and plaque material were aspirated. In 18 (9%) of 199 patients, the thrombus was organized, and in 70 patients (35%), the thrombus showed lytic changes, whereas in 98 (49%), a completely fresh thrombus was found. In 14 (7%) of 199 patients, the thrombus showed combined features of both fresh thrombus and organized thrombus. Conclusions-In at least 50% of patients with acute STEMI, coronary thrombi were days or weeks old. This indicates that sudden coronary occlusion is often preceded by a variable period of plaque instability and thrombus formation, initiated days or weeks before onset of symptoms.

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“…Similar findings were published for great groups of cerebral stroke (CVA) [16]. Recent studies confirmed that more than 75% of AMI are a result of atheroma fissuring and/or rupture [37][38][39] and strong links connect timing of these events with high CRA (neutron activity).…”

High‐Resolution Imaging of Interaction Between Thrombus and Stent‐Retriever in Patients With Acute Ischemic Stroke

“…Cholesterol crystals were not observed. Nuclear fragmentation was present in all but 1 thrombus, indicating thrombi were older than 1 day according to the criteria by Rittersma et al 18. Hematoxylin‐eosin staining of thrombi revealed areas of different age with fibrin networks of variable density and both intact leukocytes and nonintact leukocytes.…”

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) .…”

“…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) . In that study, 50% of the thrombi were days or weeks old.…”