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Published on: January 28, 2020
Inflammatory cell content of coronary thrombi is dependent on thrombus age in patients with ST-elevation myocardial
Wessel W Fuijkschot1, Wouter E Groothuizen2, Yolande Appelman3
1Department of Internal Medicine, VU University Medical Center, Amsterdam, the Netherlands; Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, the Netherlands; Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands.
Insights
Inflammatory cell composition in ST-elevation myocardial infarction (STEMI) thrombi varies with age and patient factors. Neutrophils and monocytes/macrophages differ based on thrombus age and patient age, while aspirin affects platelet area.
Area of Science:
- Cardiovascular Research
- Immunology
- Pathology
Background:
- ST-elevation myocardial infarction (STEMI) is primarily caused by occlusive coronary thrombus.
- The precise mechanisms of intracoronary thrombus formation remain unclear.
- The role of inflammatory cells in coronary thrombosis is not well-defined, unlike in venous thrombi.
Purpose of the Study:
- To investigate the composition of inflammatory cells within STEMI thrombi.
- To correlate inflammatory cell presence with thrombus age.
- To explore the influence of patient age and medication on thrombus composition.
Main Methods:
- Prospective collection of thrombus aspirates from 113 STEMI patients undergoing primary percutaneous coronary intervention.
- Histological classification of thrombi into fresh, lytic, or organized using hematoxylin and eosin staining.
- Immunohistochemical analysis of neutrophils (MPO), monocytes/macrophages (CD68), lymphocytes (CD45), and platelet area (CD31).
Main Results:
- Fresh thrombi constituted the majority (76.1%).
- Neutrophil density decreased significantly in organized thrombi compared to fresh and lytic thrombi.
- Monocyte/macrophage density was higher in lytic thrombi than in fresh thrombi.
- Younger patients (<50 years) had more neutrophils and monocytes/macrophages irrespective of thrombus age.
- Aspirin use was associated with a smaller platelet area, independent of thrombus age.
Conclusions:
- Inflammatory cell composition in STEMI thrombi is dynamic and changes with thrombus age.
- Patient age and medication (aspirin) significantly influence thrombus composition.
- These findings provide insights into the inflammatory processes underlying coronary thrombosis in STEMI.
Background:
ST-elevation myocardial infarction (STEMI) is typically caused by an occlusive coronary thrombus. The process of intracoronary thrombus formation is poorly understood. It is known that inflammatory cells play a role in the formation and resolution of venous thrombi, however their role in coronary thrombosis is not clear. We therefore analyzed inflammatory cells in thrombi derived from patients with STEMI in relation to histologically classified thrombus age.
Methods:
Thrombus aspirates of 113 patients treated with primary percutaneous coronary intervention were prospectively collected and classified (fresh, lytic, or organized) based on hematoxylin and eosin staining. The density of inflammatory cells neutrophils (MPO), monocytes/macrophages (CD68), lymphocytes (CD45), and the platelet area (CD31), were visualized using immunohistochemistry. Patients' history, medication, and laboratory data were registered.
Results:
Fresh thrombi (76.1%) were the most abundant as compared to lytic (16.8%) and organized (7.1%) thrombi. Neutrophils were significantly less present in organized (169cells/mm2) compared to fresh (327 cells/mm2) and lytic thrombi (311 cells/mm2). Monocytes/macrophages were significantly more present in lytic (471 cells/mm2) than in fresh (312 cells/mm2) thrombi. We additionally found that thrombi from patients aged <50 years as compared to >50 years old contained significantly more neutrophils and monocytes/macrophages irrespective of thrombus age. Furthermore platelet area was smaller in patients on aspirin again irrespective of thrombus age. No gender differences were found.
Conclusions:
The composition of inflammatory cells differs with thrombus age in thrombosuction material of STEMI patients that in part depends on patient age and medication.
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