Plaque instability frequently occurs days or weeks before occlusive coronary thrombosis: a pathological thrombectomy...

Area of Science:

• Cardiology
• Pathology
• Biomedical Engineering

Background:

• Acute ST-elevation myocardial infarction (STEMI) results from sudden coronary thrombosis following plaque disruption.
• A significant time gap between plaque disturbance and symptom onset in STEMI is hypothesized.
• This study investigates the age of intracoronary thrombi in STEMI patients.

Purpose of the Study:

• To determine the age of intracoronary thrombi in patients experiencing acute ST-elevation myocardial infarction (STEMI).
• To understand the timeline of plaque instability and thrombus formation preceding STEMI symptoms.

Main Methods:

• 211 consecutive STEMI patients undergoing percutaneous intracoronary thrombectomy within 6 hours of symptom onset were studied.
• Aspirated material was histologically analyzed for thrombus and plaque components.
• Thrombus age was categorized as fresh (<1 day), lytic (1-5 days), or organized (>5 days).

Main Results:

• Thrombus was identified in 95% of patients (199/211).
• Organized thrombi were found in 9% (18/199), lytic thrombi in 35% (70/199), and fresh thrombi in 49% (98/199).
• Combined fresh and organized thrombus features were present in 7% (14/199) of patients.

Conclusions:

• In at least 50% of STEMI patients, coronary thrombi were days or weeks old.
• Sudden coronary occlusion in STEMI is frequently preceded by days or weeks of plaque instability and thrombus development.
• These findings suggest a prolonged preclinical phase of atherothrombosis in STEMI.