title: Coronary thrombi neovascularization in patients with ST-elevation myocardial infarction - clinical and angiographic implications.
abstract: BACKGROUND
  Coronary artery thrombosis in ST-elevation myocardial infarction (STEMI) is a dynamic process often preceded by episodes of silent plaque rupture and subocclusive thrombosis. Thrombus organization is achieved by ingrowth of endothelial and smooth muscle cells. Clinical significance and impact of thrombus neovascularization on primary percutaneous coronary intervention (pPCI) outcome remain unclear. Therefore we investigated composition and neovascularization of thrombi aspirated during pPCI and their association with clinical and angiographic parameters of STEMI patients.
  
  
  METHODS
  Aspirated thrombi retrieved from 84 STEMI patients were classified as fresh (<1 day), lytic (1-5 days) or organized (>5 days). Thrombus neovascularization was evaluated immunohistochemically using CD34, CD31 and VEGF antibodies. CD34 and CD31 immunopositive (CD34/CD31+) cells were organized as single, clusters and microvessels. VEGF positivity was graded as low or high, based on thrombus surface immunopositive area.
  
  
  RESULTS
  CD34/CD31+ cells were present in 67% of all aspirated thrombi. Thrombus CD34/CD31 positivity was associated with previous history of angina pectoris (χ(2)=6.142, p=0.013) and lower myocardial blush grade (MBG<3, χ(2)=12.602, p<0.001). Organization of CD34/CD31+ cells showed inverse association with the extent of VEGF positivity (χ(2)=10.607, p=0.005). Fresh thrombi were associated with shorter ischemic time (U=237.5, p=0.002) and MBG 3 (χ(2)=6.379, p=0.012).
  
  
  CONCLUSIONS
  Older thrombus age and neovascularization are associated with suboptimal myocardial perfusion in STEMI patients. Thrombus VEGF expression is inversely associated with degree of CD34+ cell organization. Therefore, neovascularization of aspirated thrombi may indicate the duration of thrombosis, coronary microcirculation status and outcome in STEMI patients.
authors.affiliation: Institute of Histology and Embryology "Aleksandar Đ. Kostić", School of Medicine, University of Belgrade, Višegradska 26, 11000 Belgrade, Serbia. Electronic address: jelena.kostic@mfub.bg.ac.rs.
authors.forename: Jelena
authors.initials: J
authors.lastname: Kostić
authors.affiliation: Cardiology Clinic, Clinical Center of Serbia, Dr Koste Todorovića 8, 11000 Belgrade, Serbia; School of Medicine, University of Belgrade, Dr Subotića 8, 11000 Belgrade, Serbia.
authors.forename: Dejan
authors.initials: D
authors.lastname: Orlić
authors.affiliation: Institute of Histology and Embryology "Aleksandar Đ. Kostić", School of Medicine, University of Belgrade, Višegradska 26, 11000 Belgrade, Serbia.
authors.forename: Milica Labudović
authors.initials: ML
authors.lastname: Borović
authors.affiliation: Cardiology Clinic, Clinical Center of Serbia, Dr Koste Todorovića 8, 11000 Belgrade, Serbia; School of Medicine, University of Belgrade, Dr Subotića 8, 11000 Belgrade, Serbia.
authors.forename: Branko
authors.initials: B
authors.lastname: Beleslin
authors.affiliation: Cardiology Clinic, Clinical Center of Serbia, Dr Koste Todorovića 8, 11000 Belgrade, Serbia.
authors.forename: Dejan
authors.initials: D
authors.lastname: Milašinović
authors.affiliation: Cardiology Clinic, Clinical Center of Serbia, Dr Koste Todorovića 8, 11000 Belgrade, Serbia.
authors.forename: Milan
authors.initials: M
authors.lastname: Dobrić
authors.affiliation: Cardiology Clinic, Clinical Center of Serbia, Dr Koste Todorovića 8, 11000 Belgrade, Serbia.
authors.forename: Milorad
authors.initials: M
authors.lastname: Tešić
authors.affiliation: Cardiology Clinic, Clinical Center of Serbia, Dr Koste Todorovića 8, 11000 Belgrade, Serbia; School of Medicine, University of Belgrade, Dr Subotića 8, 11000 Belgrade, Serbia.
authors.forename: Miodrag
authors.initials: M
authors.lastname: Ostojić
mesh_terms: D000368:Aged; D018952:Antigens, CD34 / Q000032:analysis; D003326:Coronary Circulation; D003328:Coronary Thrombosis / Q000150:complications* / Q000473:pathology* / Q000601:surgery; D042783:Endothelial Cells / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D009389:Neovascularization, Pathologic / Q000150:complications* / Q000473:pathology; D019408:Platelet Endothelial Cell Adhesion Molecule-1 / Q000032:analysis; D017131:Thrombectomy; D042461:Vascular Endothelial Growth Factor A / Q000032:analysis
chemical_list: D018952:Antigens, CD34; D019408:Platelet Endothelial Cell Adhesion Molecule-1; D042461:Vascular Endothelial Growth Factor A
keywords: Acute myocardial infarction; Aspiration; Neovascularization; STEMI; Thrombectomy; Thrombus