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Optical and Scanning Electron Microscopy Thrombus Findings in Patients with STEMI Undergoing Primary Versus Rescue

Stella Marinelli Pedrini1, Thiago P A Aloia2, André H Aguillera3

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Thrombus composition differs between ST-elevation myocardial infarction patients undergoing rescue PCI versus primary PCI. Rescue PCI patients had more erythrocytes and cholesterol crystals, and less fibrin, potentially explaining fibrinolysis failure.

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acute myocardial infarctionfibrinolytic failureoptical microscopypercutaneous coronary interventionscanning electron microscopythrombus

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Area of Science:

  • Cardiovascular Medicine
  • Biomedical Engineering
  • Pathology

Background:

  • Fibrinolysis failure in ST-elevation myocardial infarction (STEMI) pharmacoinvasive strategies may stem from thrombus architecture and composition.
  • Understanding these differences is crucial for optimizing treatment strategies.

Purpose of the Study:

  • To compare thrombus composition between STEMI patients undergoing rescue percutaneous coronary intervention (rPCI) and primary percutaneous coronary intervention (pPCI).
  • To investigate the role of thrombus composition in fibrinolysis failure.

Main Methods:

  • Prospective enrollment of 53 STEMI patients (25 rPCI, 28 pPCI).
  • Thrombus aspiration followed by analysis using optical microscopy (OM) and scanning electron microscopy (SEM).
  • OM evaluated hematoxylin-eosin-stained samples at 60x magnification; SEM analyzed at 5000x magnification.

Main Results:

  • rPCI patients had higher C-reactive protein levels and longer ischemic intervals (9.92h vs 2.14h).
  • OM revealed significantly higher erythrocyte area percentage (18.36% vs 0.91%) and lower fibrin content (79.49% vs 94.43%) in rPCI thrombi.
  • SEM showed a greater amount of cholesterol crystals in rPCI thrombi (1.73 μm² vs 0.08 μm²).

Conclusions:

  • Thrombi in STEMI patients undergoing rPCI exhibit higher erythrocyte and cholesterol crystal content compared to those undergoing pPCI.
  • A reduced fibrin area in rPCI thrombi was also observed.
  • These compositional differences may contribute to the observed failure of fibrinolytic therapy in the pharmacoinvasive strategy for rPCI patients.