title: Thrombus composition in sudden cardiac death from acute myocardial infarction.
abstract: It was hypothesized that the pattern of coronary occlusion (thrombus composition) might contribute to the onset of ventricular arrhythmia and sudden cardiac death (SCD) in myocardial infarction (MI).
  
  
  
  The TIDE (Thrombus and Inflammation in sudden DEath) study included patients with angiographically-proven acute coronary occlusion as the cause of a ST elevation MI (STEMI) complicated by Sudden Cardiac Death (SCD group) or not (STEMI group). Thrombi were obtained by thrombo-aspiration before primary percutaneous coronary stenting and analyzed with a quantitative method using scanning electron microscopy. We compared the composition of the thrombi responsible for the coronary occlusion between the two groups and evaluated factors influencing its composition.
  
  
  
  We included 121 patients and found that thrombus composition was not different between the SCD group (n=23) and the STEMI group (n=98) regarding content of fibrin fibers (60.3±18.4% vs. 62.4±18.4% respectively, p=0.68), platelets (16.3±19.2% vs. 15.616.7±%, p=0.76), erythrocytes (14.6±12.5% vs. 13±12.1%, p=0.73) and leukocytes (0.6±0.9% vs. 0.8±1.5%, p=0.93). Thrombus composition did not differ between patients receiving upstream-use of glycoprotein IIb/IIIa platelet receptor inhibitors (GPI) and patients free of GPI. The only factor found to influence thrombus composition was the ischemic time from symptom onset to primary PCI, with a decreased content in fibrin fibers (57.8±18.5% vs. 71.9±10.1%, p=0.0008) and a higher platelet content (19.2±19.1% vs. 7.9±5.7% p=0.014) in early presenters (<3h of ischemic time) vs. late presenters (>6h of ischemic time).
  
  
  
  Composition of intracoronary thrombi in STEMI patients does not differ between those presenting with and without SCD. Time from symptom onset to coronary reperfusion seems to be the strongest factor influencing thrombus composition in MI.
authors.affiliation: Sorbonne Université - Univ Paris 06 (UPMC), ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France. Electronic address: johanne.silvain@aphp.fr.
authors.forename: Johanne
authors.initials: J
authors.lastname: Silvain
authors.affiliation: Sorbonne Université - Univ Paris 06 (UPMC), ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Collet
authors.affiliation: Sorbonne Université - Univ Paris 06 (UPMC), ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Guedeney
authors.affiliation: Cardiology Department, Cochin Hospital, Paris 5 School of Medicine, Rene Descartes University, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Varenne
authors.affiliation: Department of Cell and Developmental Biology, University of Pennsylvania School of Medicine, Philadelphia, PA, United States.
authors.forename: Chandrasekaran
authors.initials: C
authors.lastname: Nagaswami
authors.affiliation: Sorbonne Université - Univ Paris 06 (UPMC), ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Maupain
authors.affiliation: Département de cardiologie, Hôpital Européen Georges Pompidou, Université Paris Descartes, Paris Cardiovascular Research Centre (PARCC), INSERM UMRS 970, Paris Sudden Death Expertise Centre, Paris, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Empana
authors.affiliation: Département de cardiologie, Hôpital Européen Georges Pompidou, Université Paris Descartes, Paris Cardiovascular Research Centre (PARCC), INSERM UMRS 970, Paris Sudden Death Expertise Centre, Paris, France.
authors.forename: Chantal
authors.initials: C
authors.lastname: Boulanger
authors.affiliation: Département de cardiologie, Hôpital Européen Georges Pompidou, Université Paris Descartes, Paris Cardiovascular Research Centre (PARCC), INSERM UMRS 970, Paris Sudden Death Expertise Centre, Paris, France.
authors.forename: Muriel
authors.initials: M
authors.lastname: Tafflet
authors.affiliation: Cardiology Department, Inserm U942, Lariboisiere Hospital, Paris Diderot University, Paris, France.
authors.forename: Stephane
authors.initials: S
authors.lastname: Manzo-Silberman
authors.affiliation: Sorbonne Université - Univ Paris 06 (UPMC), ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Kerneis
authors.affiliation: Sorbonne Université - Univ Paris 06 (UPMC), ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Brugier
authors.affiliation: Sorbonne Université - Univ Paris 06 (UPMC), ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Vignolles
authors.affiliation: Department of Cell and Developmental Biology, University of Pennsylvania School of Medicine, Philadelphia, PA, United States.
authors.forename: John W
authors.initials: JW
authors.lastname: Weisel
authors.affiliation: Département de cardiologie, Hôpital Européen Georges Pompidou, Université Paris Descartes, Paris Cardiovascular Research Centre (PARCC), INSERM UMRS 970, Paris Sudden Death Expertise Centre, Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Jouven
authors.affiliation: Sorbonne Université - Univ Paris 06 (UPMC), ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Montalescot
authors.affiliation: Département de cardiologie, Hôpital Européen Georges Pompidou, Université Paris Descartes, Paris Cardiovascular Research Centre (PARCC), INSERM UMRS 970, Paris Sudden Death Expertise Centre, Paris, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Spaulding
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000473:pathology; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008855:Microscopy, Electron, Scanning / Q000379:methods; D008875:Middle Aged; D000072658:Non-ST Elevated Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D017063:Outcome Assessment, Health Care; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011446:Prospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D017131:Thrombectomy / Q000379:methods*; D061665:Time-to-Treatment
keywords: Coronary thrombus; ST elevated myocardial infarction; Sudden cardiac death