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 |
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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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