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Composition of Coronary Thrombus in Acute Myocardial Infarction

Open access
Silvain, Johanne, Collet, Jean-Philippe, Nagaswami, Chandrasekaran, Beygui, Farzin, Edmondson, Kathryn E., Bellemain-Appaix, Anne, Cayla, Guillaume, Pena, Ana, Brugier, Delphine, Barthelemy, Olivier, Montalescot, Gilles, Weisel, John W.·2011·Journal of the American College of Cardiology

Abstract

Objective To analyse composition of coronary thrombus in vivo, in ST-elevation Myocardial Infarction (STEMI) patients. Background The dynamic process of intracoronary thrombus formation in STEMI patients is poorly understood. Methods Intracoronary thrombi (n=45) were obtained by thromboaspiration in 288 consecutive STEMI patients presenting for primary percutaneous intervention and analyzed using high definition pictures taken with a scanning electron microscope. Plasma biomarkers (TnI, CRPus, IL-6, PAI-1, sCD40 ligand and TNF-α) and plasma fibrin clots viscoelastic properties were measured simultaneously on peripheral blood. Results Thrombi were mainly composed of fibrin (55.9±18%) with platelets (16.8±18%), erythrocytes (11.5±9%), cholesterol crystal (5.2±8.4%) and leukocytes (1.3±2.0%). The median ischemic time was 175 min [IQR 140-297]. Ischemic time impacted thrombi composition, resulting in a positive correlation with intracoronary thrombus fibrin content, r=0.38, p=0.01 and a negative correlation with platelet content r=-0.34, p=0.02. Thus, fibrin content increased with ischemic time, ranging from 48.4±21% (<3 hours) up to 66.9±9% (>6 hours) (p=0.02), while platelet content decreased from 24.9±23% (<3 hours) to 9.1±6% (>6 hours) (p=0.07). Soluble CD40 ligand was positively correlated to platelet content in the thrombus (r=0.40, p=0.02) and negatively correlated with fibrin content (r=-0.36; p=0.04). Multivariate analysis indicated that ischemic time was the only predictor of thrombus composition with a 2-fold increase of fibrin-content per ischemic hour (adjusted OR2 [1.03-3.7] p=0.01). Conclusions In acute STEMI, platelet and fibrin contents of the occlusive thrombus are highly dependent of ischemic time, which may have a direct impact on the efficacy of drugs or devices used for coronary reperfusion.

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Metadata

Authors
Silvain, J., Collet, J.-P., Nagaswami, C., Beygui, F., Edmondson, K. E., Bellemain-Appaix, A., Cayla, G., Pena, A., Brugier, D., Barthelemy, O., Montalescot, G., & Weisel, J. W.
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
2011-03
Volume
57
Issue
12
Pages
1359-1367
ISSN
0735-1097 (ISSN-L)
OpenAlex
W2107371049
Cited by
393
References
28
FWCI
21.33
Type
journal article
Language
en
Open access
bronze

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CoChat. (2026). Citation check: Composition of Coronary Thrombus in Acute Myocardial Infarction. https://app.cochat.ai/papers/10.1016/j.jacc.2010.09.077
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Silvain, J., Collet, J.-P., Nagaswami, C., Beygui, F., Edmondson, K. E., Bellemain-Appaix, A., Cayla, G., Pena, A., Brugier, D., Barthelemy, O., Montalescot, G., & Weisel, J. W. (2011). Composition of Coronary Thrombus in Acute Myocardial Infarction. Journal of the American College of Cardiology. https://doi.org/10.1016/j.jacc.2010.09.077

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