title: Relationship of thrombus characteristics to the incidence of angiographically visible distal embolization in patients with ST-segment elevation myocardial infarction treated with thrombus aspiration.
abstract: OBJECTIVE
  This study sought to investigate the association between pathological characteristics of aspirated intracoronary thrombi and the incidence of angiographically visible distal embolization (AVDE) during primary percutaneous coronary intervention (p-PCI) in patients with ST-segment elevation myocardial infarction (STEMI) treated with thrombus aspiration.
  
  
  BACKGROUND
  AVDE of atherosclerotic and thrombotic material has been shown to impair myocardial perfusion and contribute to poor clinical outcome in patients with STEMI. Recent studies have shown that thrombus composition and size are associated with the incidence of AVDE.
  
  
  METHODS
  Aspirated thrombi from 164 STEMI patients within 12 h of symptom onset were investigated immunohistochemically using antibodies against platelets, erythrocytes, and inflammatory cells.
  
  
  RESULTS
  The angiographic results showed that AVDE during p-PCI occurred in 22 (13.4%) patients. Pathological analysis revealed that thrombi from patients with AVDE had a greater erythrocyte-positive area (60 ± 15% vs. 43 ± 21%, p < 0.0005) and more myeloperoxidase-positive cells (943 ± 324 cells/mm(2) vs. 592 ± 419 cells/mm(2), p < 0.0005) than those from patients without AVDE. Thrombus size, quantified as the thrombus surface area, was positively correlated with the erythrocyte component (r = 0.362, p < 0.0001). Moreover, multivariate logistic analysis demonstrated that erythrocyte-positive area in the thrombi, glucose levels on admission, larger vessel diameter (≥ 3.5 mm), and pre-balloon dilation were independent predictors of the incidence of AVDE.
  
  
  CONCLUSIONS
  This study demonstrated that the erythrocyte-rich component of aspirated thrombi may be associated with the incidence of AVDE during p-PCI in patients with STEMI.
authors.affiliation: Department of Cardiology, Osaka City General Hospital, Osaka, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Yunoki
authors.forename: Takahiko
authors.initials: T
authors.lastname: Naruko
authors.forename: Takeshi
authors.initials: T
authors.lastname: Inoue
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sugioka
authors.forename: Mayumi
authors.initials: M
authors.lastname: Inaba
authors.forename: Yoko
authors.initials: Y
authors.lastname: Iwasa
authors.forename: Ryushi
authors.initials: R
authors.lastname: Komatsu
authors.forename: Akira
authors.initials: A
authors.lastname: Itoh
authors.forename: Kazuo
authors.initials: K
authors.lastname: Haze
authors.forename: Minoru
authors.initials: M
authors.lastname: Yoshiyama
authors.forename: Anton E
authors.initials: AE
authors.lastname: Becker
authors.forename: Makiko
authors.initials: M
authors.lastname: Ueda
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D015415:Biomarkers / Q000378:metabolism; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D004617:Embolism / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000378:metabolism / Q000473:pathology; D004912:Erythrocytes / Q000378:metabolism; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012307:Risk Factors; D013396:Suction; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers