title: Thrombus age, clinical presentation, and reperfusion grade in myocardial infarction.
abstract: BACKGROUND
  Autopsy studies show that dynamic coronary thrombosis leads to infarction. We studied intracoronary thrombus age in ST-segment elevation myocardial infarction (STEMI) and its relationship with clinical presentation and epicardial reperfusion grade.
  
  
  RESULTS
  Intracoronary thrombectomy was performed in 131 STEMI patients within 24 h after symptom onset, and material sufficient for pathological analysis was retrieved from 81 patients. Thrombus age was classified as fresh (<1day), lytic (1 to 5 days), or organized (>5days). A fresh thrombus was found in 48 patients (60%), whereas the thrombus showed lytic or organized changes in 33 patients (40%). Both thrombus and plaque material were aspirated in 40% of cases. Lytic or organized thrombi were aspirated in one third of the cases early (<12h) after symptom onset, and fresh thrombi were also aspirated in one third of STEMI of>12h evolution. In multivariable analysis, fresh thrombus was associated with both persistent ST-segment elevation (even after 12 h of onset) during percutaneous coronary intervention [odds ratio (OR) 4.23, 95% confidence interval (CI) 1.05-17.42, P=.042) and a previous history of ischemic heart disease (OR 4.54, 95% CI 1.41-14.64, P=.011). There were no associations between thrombus composition and epicardial reperfusion grade or the presence of the no-reflow phenomenon. Plaque components were found in all cases of distal embolization (5%).
  
  
  CONCLUSIONS
  Intracoronary thrombi aspirated in STEMI frequently show more than one stage of maturation. Fresh thrombi predominate in patients with known ischemic heart disease or persistent ST-segment elevation.
  
  
  CONCLUSIONS
  In STEMI, thromboaspiration revealed thrombi at different stages of maturation, supporting a dynamic process of rupture and repair of the atherosclerotic plaque. Fresh thrombi were present more frequently within 12 h of infarction onset but also in patients with symptoms beyond 12 h. When containing plaque material, thrombi were often associated with macroscopic distal embolization during angioplasty.
authors.affiliation: Cardiology Service, Hospital Universitari Germans Trias i Pujol, Badalona. Electronic address: 35955acr@comb.es.
authors.forename: Antoni
authors.initials: A
authors.lastname: Carol
authors.affiliation: Pathology Service, Hospital General de Granollers.
authors.forename: Mariana
authors.initials: M
authors.lastname: Bernet
authors.affiliation: Cardiology Service, Hospital Universitari Germans Trias i Pujol, Badalona.
authors.forename: Antoni
authors.initials: A
authors.lastname: Curós
authors.affiliation: Cardiology Service, Hospital Universitari Germans Trias i Pujol, Badalona.
authors.forename: Oriol
authors.initials: O
authors.lastname: Rodríguez-Leor
authors.affiliation: Cardiology Service, Hospital Universitari Germans Trias i Pujol, Badalona.
authors.forename: Jordi
authors.initials: J
authors.lastname: Serra
authors.affiliation: Cardiology Service, Hospital Universitari Germans Trias i Pujol, Badalona.
authors.forename: Eduard
authors.initials: E
authors.lastname: Fernández-Nofrerías
authors.affiliation: Cardiology Service, Hospital Universitari Germans Trias i Pujol, Badalona.
authors.forename: Josepa
authors.initials: J
authors.lastname: Mauri
authors.affiliation: Cardiology Service, Hospital Universitari Germans Trias i Pujol, Badalona.
authors.forename: Antoni
authors.initials: A
authors.lastname: Bayes-Genís
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000150:complications / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy; D003326:Coronary Circulation; D003328:Coronary Thrombosis / Q000150:complications / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention; D058226:Plaque, Atherosclerotic; D011446:Prospective Studies; D020127:Recovery of Function; D012307:Risk Factors; D012422:Rupture, Spontaneous; D017131:Thrombectomy; D013997:Time Factors; D016896:Treatment Outcome
keywords: Coronary angioplasty; Embolization; Myocardial infarction; Pathology; Reperfusion; Thrombus