on February 22, 2005
Published online before print February 21, 2005, doi: 10.1161/01.CIR.0000157141.00778.AC
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Submitted on September 22, 2004
From the Departments of Cardiology (S.Z.H.R., K.T.K., J.J.P., J.P.S.H., K.J.M., M.M., R.J.d.W.) and Pathology (A.C.v.d.W., J.P.H.M.P.), Academic Medical Center, Amsterdam, the Netherlands. * To whom correspondence should be addressed. E-mail: r.j.dewinter{at}amc.uva.nl.
Background--Acute ST-elevation myocardial infarction (STEMI) is caused by sudden occlusive coronary thrombosis, after plaque disruption; however, a considerable time interval between plaque disturbance and the onset of symptoms has been suggested. We therefore studied the age of intracoronary thrombi, aspirated during angioplasty in patients with acute STEMI. Methods and Results--Percutaneous intracoronary thrombectomy during angioplasty was performed in 211 consecutive STEMI patients within 6 hours after onset of anginal symptoms. The aspirated material was histologically screened on thrombus and plaque components, and thrombus age was classified as fresh (<1 day), lytic thrombus (1 to 5 days), and organized thrombus (>5 days). In all patients, intracoronary-derived material was retrieved in the filter of the collection bottle. Thrombus was identified in 199 (95%) of 211 patients. In 12 patients (5%), only plaque components were identified, and in 85 patients (41%), both thrombus and plaque material were aspirated. In 18 (9%) of 199 patients, the thrombus was organized, and in 70 patients (35%), the thrombus showed lytic changes, whereas in 98 (49%), a completely fresh thrombus was found. In 14 (7%) of 199 patients, the thrombus showed combined features of both fresh thrombus and organized thrombus. Conclusions--In at least 50% of patients with acute STEMI, coronary thrombi were days or weeks old. This indicates that sudden coronary occlusion is often preceded by a variable period of plaque instability and thrombus formation, initiated days or weeks before onset of symptoms.
Revised on November 23, 2004
Accepted on November 29, 2004
Plaque Instability Frequently Occurs Days or Weeks Before Occlusive Coronary Thrombosis. A Pathological Thrombectomy Study in Primary Percutaneous Coronary Intervention
Saskia Z.H. Rittersma MD,
Key words: myocardial infarction • thrombus • occlusion
Related Article:
Circulation 2005 111: 1093.
This article has been cited by other articles:
 |
|
 |
|
  M. C.A. Kramer, S. Z.H. Rittersma, R. J. de Winter, E. R. Ladich, D. R. Fowler, Y.-H. Liang, R. Kutys, N. Carter-Monroe, F. D. Kolodgie, A. C. van der Wal, et al. Relationship of Thrombus Healing to Underlying Plaque Morphology in Sudden Coronary Death J. Am. Coll. Cardiol., October 7, 2009; (2009) j.jacc.2009.09.007v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R.-J. J.H.M. Miserus, M. V. Herias, L. Prinzen, M. B.I. Lobbes, R.-J. Van Suylen, A. Dirksen, T. M. Hackeng, J. W.M. Heemskerk, J. M.A. van Engelshoven, M. J.A.P. Daemen, et al. Molecular MRI of Early Thrombus Formation Using a Bimodal {alpha}2-Antiplasmin-Based Contrast Agent J. Am. Coll. Cardiol. Img., August 1, 2009; 2(8): 987 - 996. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. C.A. Kramer, K. T. Koch, R. J. van der Schaaf, J. P.S. Henriques, J. Baan Jr, S. Z.H. Rittersma, M. M. Vis, J. J. Piek, J. G.P. Tijssen, R. J. de Winter, et al. Response to Letters Regarding Article, "Presence of Older Thrombus Is an Independent Predictor of Long-Term Mortality in Patients With ST-Elevation Myocardial Infarction Treated With Thrombus Aspiration During Primary Percutaneous Coronary Intervention" Circulation, July 7, 2009; 120(1): e5 - e5. [Full Text] [PDF]
|
|
|
|
 |
|
 G. E. Yazici, M. Erden, G. A. Tacoy, B. B. Yavuz, S. Turkoglu, and T. Timurkaynak The Optimal Time of Elective Percutaneous Coronary Intervention for Stable Patients After ST Elevation Myocardial Infarction Angiology, February 1, 2009; 60(1): 67 - 73. [Abstract] [PDF]
|
|
|
|
 |
|
 Authors/Task Force Members, F. Van de Werf, J. Bax, A. Betriu, C. Blomstrom-Lundqvist, F. Crea, V. Falk, G. Filippatos, K. Fox, K. Huber, et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology: Eur. Heart J., December 1, 2008; 29(23): 2909 - 2945. [Full Text] [PDF]
|
|
|
|
|
|
M. C.A. Kramer, A. C. van der Wal, K. T. Koch, J. P.H.M. Ploegmakers, R. J. van der Schaaf, J. P.S. Henriques, J. Baan Jr, S. Z.H. Rittersma, M. M. Vis, J. J. Piek, et al. Presence of Older Thrombus Is an Independent Predictor of Long-Term Mortality in Patients With ST-Elevation Myocardial Infarction Treated With Thrombus Aspiration During Primary Percutaneous Coronary Intervention Circulation, October 28, 2008; 118(18): 1810 - 1816. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y.L. Gu, M.L. Fokkema, and F. Zijlstra The Emerging Role of Thrombus Aspiration in the Management of Acute Myocardial Infarction Circulation, October 28, 2008; 118(18): 1780 - 1782. [Full Text] [PDF]
|
|
|
|
 |
|
 C. Di Mario and G. Ferrante Embolization: The "Dark Side" of Percutaneous Coronary Interventions J. Am. Coll. Cardiol. Intv., June 1, 2008; 1(3): 277 - 278. [Full Text] [PDF]
|
|
|
|
 |
|
 T. Svilaas, P. J. Vlaar, I. C. van der Horst, G. F.H. Diercks, B. J.G.L. de Smet, A. F.M. van den Heuvel, R. L. Anthonio, G. A. Jessurun, E.-S. Tan, A. J.H. Suurmeijer, et al. Thrombus Aspiration during Primary Percutaneous Coronary Intervention N. Engl. J. Med., February 7, 2008; 358(6): 557 - 567. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Angelini, M. Della Barbera, and G. Thiene Interventional procedures for atherothrombosis: pathology of retrieved material Heart, October 1, 2007; 93(10): 1301 - 1308. [Full Text] [PDF]
|
|
|
|
|
|
J. E. Deanfield, J. P. Halcox, and T. J. Rabelink Endothelial Function and Dysfunction: Testing and Clinical Relevance Circulation, March 13, 2007; 115(10): 1285 - 1295. [Full Text] [PDF]
|
|
|
|
 |
|
 B. Pavy, M. C. Iliou, P. Meurin, J.-Y. Tabet, S. Corone, and for the Functional Evaluation and Cardiac Rehabili Safety of Exercise Training for Cardiac Patients: Results of the French Registry of Complications During Cardiac Rehabilitation Arch Intern Med, November 27, 2006; 166(21): 2329 - 2334. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. A. Rodriguez-Granillo, H. M. Garcia-Garcia, M. Valgimigli, S. Vaina, C. van Mieghem, R. J. van Geuns, M. van der Ent, E. Regar, P. de Jaegere, W. van der Giessen, et al. Global characterization of coronary plaque rupture phenotype using three-vessel intravascular ultrasound radiofrequency data analysis Eur. Heart J., August 2, 2006; 27(16): 1921 - 1927. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.N.E. Redgrave, J.K. Lovett, P.J. Gallagher, and P.M. Rothwell Histological Assessment of 526 Symptomatic Carotid Plaques in Relation to the Nature and Timing of Ischemic Symptoms: The Oxford Plaque Study Circulation, May 16, 2006; 113(19): 2320 - 2328. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. E. Hellings, B. A.N. Verhoeven, F. L. Moll, T. V. d. Broek, and G. Pasterkamp Pathophysiology of Gender Difference in Prognosis of Asymptomatic Carotid Stenosis: Research and Future Implications Stroke, February 1, 2006; 37(2): 332 - 332. [Full Text] [PDF]
|
|
|
|
|
|
M. Sirol, V. Fuster, J. J. Badimon, J. T. Fallon, J.-F. Toussaint, and Z. A. Fayad Chronic Thrombus Detection With In Vivo Magnetic Resonance Imaging and a Fibrin-Targeted Contrast Agent Circulation, September 13, 2005; 112(11): 1594 - 1600. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Minerva BMJ, June 11, 2005; 330(7504): E361 - E361. [Full Text] [PDF]
|
|
|
|
|
|
Minerva BMJ, March 26, 2005; 330(7493): 738 - 738. [Full Text] [PDF]
|
|