Abstract 11501: Erythrocyte-Rich Thrombus as a Predictor of Angiographic Visible Distal Embolization in Patients with ST-Elevation Myocardial Infarction Treated by Thrombus Aspiration
Background: Angiographic visible distal embolization (AVDE) of atherosclerotic and thrombotic material has been shown to impair myocardial perfusion and contribute to poor clinical outcome in patients with ST-elevation myocardial infarction (STEMI). Recent studies have shown that thrombus composition and size are related to the incidence of AVDE. We investigated the association between the detailed pathological characteristics of aspirated intracoronary thrombi and the incidence of AVDE after primary percutaneous coronary intervention (p-PCI) in patients with STEMI treated by thrombus aspiration.
Methods: The characteristics of aspirated thrombi from 164 STEMI patients within 12 hours of symptom onset were investigated by immunostaining using antibodies against platelets, erythrocytes, neutrophils and myeloperoxidase (MPO).
Results: The angiographic results showed that AVDE after p-PCI occurred in 22 (13.4%) patients. Immunohistochemical analysis revealed that the percentage of erythrocyte- positive area and the number of neutrophils and MPO-positive cells was significantly greater in patients with than without AVDE (erythrocyte: 60 ± 15% vs. 43 ± 21%, P<0.0005; neutrophils: 703 ± 376 vs. 423 ± 346 cells/mm2, p<0.005; MPO-positive cells: 943 ± 324 vs. 592 ± 419 cells/mm2, P<0.0005). Thrombus size was positively correlated with the erythrocyte component (r = 0.362, P<0.0001) and negatively correlated with the platelet component of coronary thrombi (r = 0.239, P<0.005). Moreover, multivariate analysis demonstrated that the percentage of the erythrocyte-positive area was an independent predictor of the incidence of AVDE (odds ratio, 1.039; 95% confidence interval, 1.010-1.069, P<0.01).
Conclusions: This study demonstrated that the erythrocyte-rich component in aspirated thrombi may be related to thrombus size and the incidence of AVDE after p-PCI in patients with STEMI treated by thrombus aspiration.
- © 2011 by American Heart Association, Inc.