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Histopathological features of aspirated thrombi after primary percutaneous coronary intervention in patients with

Miranda C Kramer1, Allard C van der Wal, Karel T Koch

  • 1Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

Plos One
|June 9, 2009
PubMed

Insights

In ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI), thrombus aspiration revealed that plaque disruption often precedes symptoms by more than 24 hours in 40% of cases. This finding has implications for understanding acute coronary syndromes.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Pathology

Background:

  • Acute coronary syndromes (ACS) predominantly result from plaque disruption and subsequent thrombus formation.
  • A temporal gap often exists between plaque disruption and thrombotic occlusion, the clinical manifestation of ACS.
  • Understanding the characteristics of aspirated material during primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) is crucial.

Purpose of the Study:

  • To determine the histopathological characteristics of aspirated material during primary PCI in STEMI patients.
  • To investigate the age of thrombus and presence of plaque components in STEMI patients.
  • To correlate histopathological findings with clinical, angiographic, and procedural data.

Main Methods:

  • Thrombus aspiration was performed in 1,362 STEMI patients undergoing primary PCI.
  • Aspirated material was analyzed for thrombus age (fresh, lytic, organized) and plaque components.
  • Histopathological findings were correlated with clinical and procedural characteristics.

Main Results:

  • Aspirated material was obtained in 74% of patients (1,009/1,362).
  • Plaque components were identified in 39% of analyzed samples (395/1,009).
  • Thrombus older than 24 hours (lytic or organized) was present in 40% of patients (382/959), while fresh thrombus was seen in 60% (577/959).
  • Distal embolization occurred more frequently in patients with lytic thrombus (21%) compared to fresh (12%) or organized (15%) thrombus.

Conclusions:

  • Thrombus aspiration is feasible in a majority of STEMI patients undergoing primary PCI.
  • A significant proportion of STEMI patients (40%) have thrombus older than 24 hours, suggesting that the underlying plaque disruption and thrombus formation often precede symptom onset.
  • These findings highlight the complex pathophysiology of STEMI and the potential for earlier intervention strategies.
Abstract

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