Plasma fibrin clot phenotype independently affects intracoronary thrombus ultrastructure in patients with acute myocardial infarction

Autor: Anetta Undas, Jadwiga Nessler, Jan Bogaert, Olga Woznicka, Jarosław Zalewski, Michał Ząbczyk, Maria Ntoumpanaki, Marcin Sadowski, Konstantinos Doulaptsis
Jazyk: angličtina
Rok vydání: 2015
Předmět:
Male
Erythrocytes
Time Factors
Platelet Aggregation
Myocardial Infarction
030204 cardiovascular system & hematology
Chest pain
0302 clinical medicine
Coronary thrombosis
Platelet
030212 general & internal medicine
Myocardial infarction
Thrombectomy
Aspirin
biology
Fibrinolysis
Hematology
Middle Aged
Clopidogrel
Coronary Vessels
Phenotype
Cardiology
Drug Therapy
Combination
Female
medicine.symptom
Porosity
medicine.drug
Blood Platelets
medicine.medical_specialty
Ticlopidine
Suction
Permeability
Fibrin
03 medical and health sciences
Percutaneous Coronary Intervention
Internal medicine
medicine
Humans
Aged
Chi-Square Distribution
business.industry
Coronary Thrombosis
medicine.disease
Multivariate Analysis
Microscopy
Electron
Scanning
Ultrastructure
biology.protein
business
Platelet Aggregation Inhibitors
Popis: summaryDeterminants of intracoronary thrombus (ICT) composition in patients with ST-elevation myocardial infarction (STEMI) are largely unknown. We sought to investigate whether plasma fibrin phenotype and platelet reactivity affect ICT ultrastructure. We assessed the content of fibrin, platelets and erythrocytes including polyhedrocytes by scanning electron microscopy on the surface and inside ICT aspirated from 80 STEMI patients within 12 hours since chest pain onset. Plasma fibrin clot permeability (Ks), which indicates the average pore size, lysis time (t50 %), platelet reactivity index (PRI) and ADP-induced platelet aggregation (ADP5,20μM) were evaluated on admission. All patients received aspirin and 45 (56.3 %) 600 mg of clopidogrel, 80 (60–120) min prior to aspiration. Higher content of fibrin (61.6 vs 34.3 %, P< 0.0001) and platelets (8.2 vs 4.8 %, P=0.018) and lower erythrocyte content (15.8 vs 42.9 %, P< 0.0001) were found on ICT surface compared with its inner part. After adjustment for fibrinogen, in both ICT parts fibrin content was correlated with Ks (r≤-0.55, P< 0.0001) and t50% (r≥ 0.29, P≤ 0.02) but not with PRI and ADP5,20μM. Polyhedrocytes were observed in 16 (20 %) patients and their large amount expressed as ≥ 50 % fields of view covered by polyhedrocytes was associated with the lower PRI values (40 vs 69 %, P=0.015), but not Ks or t50%. By multivariate regression, Ks (β=-0.62, P< 0.0001), clopidogrel pretreatment (β=-0.36, P< 0.001), ischemia time (β=0.19, P=0.044) and family history (β=0.18, P=0.049) independently predicted fibrin content in the whole ICT (R2=0.65, P< 0.0001). Formation of denser plasma fibrin clots is independently associated with high fibrin content within the ICT in STEMI.
Databáze: OpenAIRE
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