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Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2017;70:170-7 - Vol. 70 Num.03 DOI: 10.1016/j.rec.2016.09.006

Immunohistological Analysis of Intracoronary Thrombus Aspirate in STEMI Patients: Clinical Implications of Pathological Findings

Ana Blasco a,, Carmen Bellas b, Leyre Goicolea a, Ana Muñiz a, Víctor Abraira c, Ana Royuela d, Susana Mingo a, Juan Francisco Oteo a, Arturo García-Touchard a, Francisco Javier Goicolea a

a Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
b Departamento de Anatomía Patológica, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
c Departamento de Estadística, Hospital Universitario Ramón y Cajal, Madrid, Spain
d Departamento de Estadística, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain

Keywords

Myocardial infarction. Coronary angioplasty. Thrombus. Pathology. Immunohistochemistry.

Abstract

Introduction and objectives

Thrombus aspiration allows analysis of intracoronary material in patients with ST–segment elevation myocardial infarction. Our objective was to characterize this material by immunohistology and to study its possible association with patient progress.

Methods

This study analyzed a prospective cohort of 142 patients undergoing primary angioplasty with positive coronary aspiration. Histological examination of aspirated samples included immunohistochemistry stains for the detection of plaque fragments. The statistical analysis comprised histological variables (thrombus age, degree of inflammation, presence of plaque), the patients’ clinical and angiographic features, estimation of survival curves, and logistic regression analysis.

Results

Among the histological markers, only the presence of plaque (63% of samples) was associated with postinfarction clinical events. Factors associated with 5-year event–free survival were the presence of plaque in the aspirate (82.2% vs 66.0%; P = .033), smoking (82.5% smokers vs 66.7% nonsmokers; P = .036), culprit coronary artery (83.3% circumflex or right coronary artery vs 68.5% anterior descending artery; P = .042), final angiographic flow (80.8% II-III vs 30.0% 0–I; P < .001) and left ventricular ejection fraction ≥ 35% at discharge (83.7% vs 26.7%; P < .001). On multivariable Cox regression analysis with these variables, independent predictors of event-free survival were the presence of plaque (hazard ratio, 0.37; 95%CI, 0.18-0.77; P = .008), and left ventricular ejection fraction (hazard ratio, 0.92; 95%CI, 0.88-0.95; P < .001).

Conclusions

The presence of plaque in the coronary aspirate of patients with ST elevation myocardial infarction may be an independent prognostic marker. CD68 immunohistochemical stain is a good method for plaque detection.

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1885-5857/© 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved