title: Immunohistological Analysis of Intracoronary Thrombus Aspirate in STEMI Patients: Clinical Implications of Pathological Findings.
abstract: OBJECTIVE
  Thrombus aspiration allows analysis of intracoronary material in patients with ST-segment elevation myocardial infarction. Our objective was to characterize this material by immunohistology and to study its possible association with patient progress.
  
  
  METHODS
  This study analyzed a prospective cohort of 142 patients undergoing primary angioplasty with positive coronary aspiration. Histological examination of aspirated samples included immunohistochemistry stains for the detection of plaque fragments. The statistical analysis comprised histological variables (thrombus age, degree of inflammation, presence of plaque), the patients' clinical and angiographic features, estimation of survival curves, and logistic regression analysis.
  
  
  RESULTS
  Among the histological markers, only the presence of plaque (63% of samples) was associated with postinfarction clinical events. Factors associated with 5-year event-free survival were the presence of plaque in the aspirate (82.2% vs 66.0%; P = .033), smoking (82.5% smokers vs 66.7% nonsmokers; P = .036), culprit coronary artery (83.3% circumflex or right coronary artery vs 68.5% anterior descending artery; P = .042), final angiographic flow (80.8% II-III vs 30.0% 0-I; P < .001) and left ventricular ejection fraction ≥ 35% at discharge (83.7% vs 26.7%; P < .001). On multivariable Cox regression analysis with these variables, independent predictors of event-free survival were the presence of plaque (hazard ratio, 0.37; 95%CI, 0.18-0.77; P = .008), and left ventricular ejection fraction (hazard ratio, 0.92; 95%CI, 0.88-0.95; P < .001).
  
  
  CONCLUSIONS
  The presence of plaque in the coronary aspirate of patients with ST elevation myocardial infarction may be an independent prognostic marker. CD68 immunohistochemical stain is a good method for plaque detection.
authors.affiliation: Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain. Electronic address: ablasc@gmail.com.
authors.forename: Ana
authors.initials: A
authors.lastname: Blasco
authors.affiliation: Departamento de Anatomía Patológica, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Bellas
authors.affiliation: Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
authors.forename: Leyre
authors.initials: L
authors.lastname: Goicolea
authors.affiliation: Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Muñiz
authors.affiliation: Departamento de Estadística, Hospital Universitario Ramón y Cajal, Madrid, Spain.
authors.forename: Víctor
authors.initials: V
authors.lastname: Abraira
authors.affiliation: Departamento de Estadística, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Royuela
authors.affiliation: Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
authors.forename: Susana
authors.initials: S
authors.lastname: Mingo
authors.affiliation: Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
authors.forename: Juan Francisco
authors.initials: JF
authors.lastname: Oteo
authors.affiliation: Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
authors.forename: Arturo
authors.initials: A
authors.lastname: García-Touchard
authors.affiliation: Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Goicolea
mesh_terms: D000359:Aftercare; D017023:Coronary Angiography / Q000401:mortality / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000401:mortality / Q000473:pathology; D003328:Coronary Thrombosis / Q000401:mortality / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data; D058226:Plaque, Atherosclerotic / Q000401:mortality / Q000473:pathology*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality / Q000473:pathology*; D012907:Smoking / Q000009:adverse effects / Q000401:mortality; D013048:Specimen Handling
keywords: Anatomía patológica; Angioplastia coronaria; Coronary angioplasty; Immunohistochemistry; Infarto de miocardio; Inmunohistoquímica; Myocardial infarction; Pathology; Thrombus; Trombo