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Updated: Apr 23, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Coronary thrombi neovascularization in patients with ST-elevation myocardial infarction - clinical and angiographic
Jelena Kostić1, Dejan Orlić2, Milica Labudović Borović1
1Institute of Histology and Embryology "Aleksandar Đ. Kostić", School of Medicine, University of Belgrade, Višegradska 26, 11000 Belgrade, Serbia.
Insights
Older thrombi and neovascularization in ST-elevation myocardial infarction (STEMI) patients correlate with poorer outcomes after primary percutaneous coronary intervention (pPCI). Thrombus age and neovascularization may predict coronary microcirculation status and patient prognosis.
Area of Science:
- Cardiovascular Research
- Interventional Cardiology
- Pathology
Background:
- ST-elevation myocardial infarction (STEMI) involves dynamic coronary artery thrombosis.
- Thrombus organization occurs via endothelial and smooth muscle cell ingrowth.
- The clinical impact of thrombus neovascularization on primary percutaneous coronary intervention (pPCI) outcomes is not well understood.
Purpose of the Study:
- To investigate the composition and neovascularization of thrombi aspirated during pPCI.
- To assess the association between thrombus characteristics and clinical/angiographic parameters in STEMI patients.
Main Methods:
- Aspirated thrombi from 84 STEMI patients were classified by age: fresh (<1 day), lytic (1-5 days), or organized (>5 days).
- Immunohistochemistry using CD34, CD31, and VEGF antibodies evaluated thrombus neovascularization.
- CD34/CD31 positive cells were assessed for organization (single, clusters, microvessels); VEGF positivity was graded (low/high).
Main Results:
- CD34/CD31 positive cells were found in 67% of thrombi.
- Thrombus CD34/CD31 positivity correlated with a history of angina and lower myocardial blush grade (MBG<3).
- Organization of CD34/CD31+ cells showed an inverse association with VEGF positivity; fresh thrombi correlated with shorter ischemic times and MBG 3.
Conclusions:
- Older thrombus age and neovascularization are linked to suboptimal myocardial perfusion in STEMI patients undergoing pPCI.
- Thrombus VEGF expression is inversely related to the degree of CD34+ cell organization.
- Thrombus neovascularization may serve as an indicator of thrombosis duration, coronary microcirculation status, and patient outcomes in STEMI.
Introduction:
Coronary artery thrombosis in ST-elevation myocardial infarction (STEMI) is a dynamic process often preceded by episodes of silent plaque rupture and subocclusive thrombosis. Thrombus organization is achieved by ingrowth of endothelial and smooth muscle cells. Clinical significance and impact of thrombus neovascularization on primary percutaneous coronary intervention (pPCI) outcome remain unclear. Therefore we investigated composition and neovascularization of thrombi aspirated during pPCI and their association with clinical and angiographic parameters of STEMI patients.
Methods:
Aspirated thrombi retrieved from 84 STEMI patients were classified as fresh (<1 day), lytic (1-5 days) or organized (>5 days). Thrombus neovascularization was evaluated immunohistochemically using CD34, CD31 and VEGF antibodies. CD34 and CD31 immunopositive (CD34/CD31+) cells were organized as single, clusters and microvessels. VEGF positivity was graded as low or high, based on thrombus surface immunopositive area.
Results:
CD34/CD31+ cells were present in 67% of all aspirated thrombi. Thrombus CD34/CD31 positivity was associated with previous history of angina pectoris (χ(2)=6.142, p=0.013) and lower myocardial blush grade (MBG<3, χ(2)=12.602, p<0.001). Organization of CD34/CD31+ cells showed inverse association with the extent of VEGF positivity (χ(2)=10.607, p=0.005). Fresh thrombi were associated with shorter ischemic time (U=237.5, p=0.002) and MBG 3 (χ(2)=6.379, p=0.012).
Conclusions:
Older thrombus age and neovascularization are associated with suboptimal myocardial perfusion in STEMI patients. Thrombus VEGF expression is inversely associated with degree of CD34+ cell organization. Therefore, neovascularization of aspirated thrombi may indicate the duration of thrombosis, coronary microcirculation status and outcome in STEMI patients.
