Author + information
- Neeraj Parakh,
- Basavaraj Utagi,
- Sudhir Arava,
- Sunil Verma,
- Ganesan Karthikeyan,
- Sandeep Singh,
- Balram Bhargava,
- Ruma Ray,
- Chetan D. Patel and
- Vinay Bahl
Background: Manual thrombus aspiration during primary percutaneous intervention (PCI) provides us with aspirated thrombus sample, histopathological analysis of which can yield valuable information.
Methods: We studied various histopathological and immunohistological features of coronary thrombus aspirated in patients with acute ST segment elevation myocardial infarction. Histopathological analysis of aspirated thrombus and immunohistological staining with CD marker for macrophages, smooth muscle actin and endothelium were done.
Results: Fifty-three patients (male – 47) with acute ST elevation myocardial infarction, who underwent primary PCI with thrombus aspiration were enrolled. Mean age of the study population was 51.3± 13 years. Thrombus was successfully aspirated in 40 out of 53 patients (75.4%). Thrombus was more successfully aspirated in patients with TIMI thrombus grade ≥4- 86.8%(33 out of 38) on angiography as compared to those who had TIMI grade ≤3- 46.3%(7 out of 15) (p=0.006) respectively. Patients who had successful thrombus aspiration had higher ST-resolution ≥50% as compared to patients who did not have a successful thrombus aspiration (87%;35/40 vs 46%;6/13 respectively). Red, white and mixed thrombus were aspirated in 30%(12/40),35%(14/40) and 35%(14/40) respectively. There was no difference in clinical, angiographic outcomes with respect to macroscopic appearance (red, white or mixed) of thrombus. However, presence of RBC rich thrombus on microscopy was significantly more commonly associated with post-procedure TIMI flow of <2(4/4-100%) as compared to patients with fibrin rich thrombus (7/33-21%) (p=0.005) and a trend towards lower myocardial blush grade <2(2/4,50% vs 4/33,12% p=0.10), but a significantly higher final infarct size (mean of 37.5 ± 5 % vs 25 ± 15% of LV myocardium respectively p=0.04); on nuclear scan. Immunohistology suggested presence of plaque material in 72% (26/36) of thrombus indicating plaque rupture as possible etiology for vessel occlusion.
Conclusions: Histopathological and immunohistological evaluation of intracoronary thrombus may be of prognostic importance and indicate possible etiology of vessel occlusion.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Insights Into Ischemic Heart Disease: Stable to Erosive Plaques
Abstract Category: 1. Acute and Stable Ischemic Heart Disease: Basic
Presentation Number: 1295-302
- 2017 American College of Cardiology Foundation