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Thrombus age, clinical presentation, and reperfusion grade in myocardial infarction

Antoni Carol1, Mariana Bernet2, Antoni Curós1

  • 1Cardiology Service, Hospital Universitari Germans Trias i Pujol, Badalona.

Cardiovascular Pathology : the Official Journal of the Society for Cardiovascular Pathology
|March 4, 2014
PubMed

Insights

Fresh coronary thrombi in ST-elevation myocardial infarction (STEMI) are linked to persistent ST elevation and prior ischemic heart disease. Thrombus age varies, indicating a dynamic atherosclerotic plaque process.

Area of Science:

  • Cardiology
  • Pathology

Background:

  • Autopsy studies link dynamic coronary thrombosis to myocardial infarction.
  • Understanding intracoronary thrombus age in STEMI is crucial for clinical management.

Purpose of the Study:

  • To investigate intracoronary thrombus age in STEMI patients.
  • To correlate thrombus age with clinical presentation and epicardial reperfusion.

Main Methods:

  • Intracoronary thrombectomy in 131 STEMI patients within 24 hours of symptom onset.
  • Pathological analysis of aspirated thrombus material from 81 patients.
  • Classification of thrombus age: fresh (<1 day), lytic (1-5 days), organized (>5 days).

Main Results:

  • Fresh thrombi were found in 60% of patients; lytic or organized thrombi in 40%.
  • Fresh thrombi were associated with persistent ST-segment elevation (OR 4.23) and history of ischemic heart disease (OR 4.54).
  • No association found between thrombus composition and reperfusion grade or no-reflow phenomenon.

Conclusions:

  • STEMI thrombi often display multiple maturation stages, reflecting dynamic plaque processes.
  • Fresh thrombi are more prevalent in patients with known ischemic heart disease or persistent ST elevation.
  • Thrombi containing plaque material were linked to distal embolization during angioplasty.
Abstract

Keywords:
Coronary angioplastyEmbolizationMyocardial infarctionPathologyReperfusionThrombus

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