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Immunohistochemical characteristics of coronary thrombi in ST-elevation myocardial infarction
Daniel Rios Pinto Ribeiro1, Marcia Moura Schmidt1, Natalia Leguisamo1
1Instituto de Cardiologia do RS/Fundação Universitária de Cardiologia do Rio Grande do Sul - IC/FUC, Brazil.
Insights
Platelet content in ST-segment elevation myocardial infarction (STEMI) thrombi is linked to heart failure history and inversely related to ischemic time. Higher platelet levels showed a trend with in-hospital major adverse cardiovascular events (MACE).
Area of Science:
- Cardiology
- Hematology
- Pathology
Background:
- Intracoronary thrombus composition in ST-segment elevation myocardial infarction (STEMI) requires further elucidation.
- Understanding thrombus markers may offer insights into STEMI pathophysiology and patient outcomes.
Purpose of the Study:
- To investigate the expression of CD34, CD61, and factor VIII in STEMI thrombi.
- To associate these markers with clinical characteristics, angiographic findings, and major adverse cardiovascular events (MACE).
Main Methods:
- Analysis of thrombi from STEMI patients undergoing aspiration thrombectomy during primary percutaneous coronary intervention (pPCI).
- Histopathological and immunohistochemical assessment of thrombus morphology and marker expression by blinded pathologists.
Main Results:
- Higher CD61 index observed in patients with a history of heart failure.
- Thrombus CD61 expression showed an inverse correlation with ischemic time.
- A trend towards higher CD61 expression was noted in patients experiencing in-hospital MACE (p=0.06).
Conclusions:
- Immunohistochemistry reveals increased platelet content in STEMI thrombi of patients with prior heart failure.
- Thrombus platelet content is inversely proportional to the duration of ischemia.
- Elevated platelet content in thrombi may be associated with adverse cardiovascular events in STEMI patients.
Background And Aims:
The dynamics and implications of intracoronary thrombus constituency in patients with ST-segment elevation myocardial infarction (STEMI) are not fully understood. We evaluated the expression of CD34, CD61and factor VIII surface markers in thrombi of patients with STEMI and its association with clinical and angiographic characteristics and major adverse cardiovascular events (MACE).
Methods:
Patients presenting with STEMI undergoing aspiration thrombectomy during primary percutaneous coronary intervention (pPCI) were included. Morphological, histopathological and immunohistochemical aspects of thrombi were assessed by two pathologists blinded to clinical variables and outcomes.
Results:
The mean age of the 245 patients included was 58 ± 12 years old, and 70 % were men. Regarding the thrombi microscopic patterns, 61 % were classified as recent, 20 % as lytic and 19 % as organized. There were higher levels of the CD61 index in patients with a history of heart failure. Smokers presented lower CD61 positive cells and CD61 index, but this association did not remain significant after multivariable analysis. There was an inverse correlation between CD61 positive cells and CD61 index with the time from onset of pain to the first medical contact, but no other significant association amongst clinical characteristics and antigenic expression. There was higher expression of the CD61 antigen in patients with in-hospital MACE, but statistical significance was borderline (p = 0.06).
Conclusions:
In this cohort of patients with STEMI, immunohistochemistry of coronary thrombus showed a significantly higher platelet content in patients with previous heart failure and a trend in those with in-hospital MACE. Thrombus' platelet content was inversely related to ischemic time.
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