| Background It has been shown that in the 2015 Chinese cardiovascular disease report cardiovascular and cerebrovascular disease had already been a leading cause of mortality worldwide,and mortality of cardiovascular disease had been a crucial role in public health and e pidemiology globally,which accounted for 43.8% of whole mortality in China.Acute myocardial infarction leaps to the uppermost cause of cardiovascular death.Atherosclerotic plaque r upture or erosion with thrombosis are a princ ipal mec hanism of total vessel occlusion and acute ST-elevation myocardial infarction(STEMI).Exposition of the lipid-rich core after atherosclerosis plaque rupture / erosion into the arterial lumen triggers the formation of unstable platelet aggregates,early fibrin formation strengthens the platelet aggregate,erythrocytes and inflammatory cells are entrapped by the fibrin networ k resulting thrombosis,which may lead to intermittent reduction in c oronary flow and cause distal embolization.The principal treatment is the primary percutaneous c oronary artery intervention(PCI).“No reflow,slow flow ”,which is caused by acute micro-thrombosis and microcirculation injury accounting for bits of thrombus or clots damaged mechanically,increases mortality in five years in primary PCI.Thrombus a spiration during primary PCI aiming to eliminate coronary arterial thrombus,offers a unique opportunity to study thrombus composition,dynamic formation and architecture in vivo,also provide s a platform for c ombination therapy of thrombus intracoronary.Objective Based on the pathology analysis of aspiration thrombus in coronary artery,the purpose of this investigation was to determine the associations between thrombus types and its infarction related artery and the prognosis of patients with STEMI.Methods 82 patients were enrolled consecutively undergoing primary PCI simultaneously accepting thrombus aspiration for high thrombus burden with STEMI(excluding ischemia time more than 36 h,without enough aspirated thrombus,after thrombolysis,etc.)from September 2012 to April 2016.Diagnostic angiography was to identify the infarction related artery(IRA),which was in high thrombus load.Thrombus aspiration catheter was selected according to the lesion in patients.Thrombus aspiration was accomplished with high-velocity saline jets contained within the distal catheter tip.These jets create d a strong negative pressure(Bernoulli effect)that entrained the thrombus to the catheter inflow windows,where it was captured,fragmented,and evacuated from the body through the catheter and associated tubing.The single-pass anterograde thrombus aspiration technique was used.Aspirated thrombus was fixed in 10% formalin immediately,then sent to department of pathology department within 24 h,and embedded by paraffin.Incise along the long axis of the specimens,slice thickness was 5 microns,then stained by hematoxylin-eosin(HE).Thrombus pathological types were divided into: white thrombi(main platelets and fibrin),red thrombi(main red blood cells),mixed thrombi(red blood cells and platelets / fibrin are equal).Compare relation between thrombus types and their IRAs.We evaluated myocardial reperfusion by thrombolysis experiment after myocardial infarction(TIMI)flow,myocardial brash classification(MBG),and corrected TIMI frame count(c TFC);evaluated left ventricular function(including LVEF and LVEDD)by cardiac ultrasonography in 7 days and 1 year;evaluated incidence rate of major adverse events of cardiovascular cerebrovascular(MACCE),assessed patients’ prognosis for 1 year.Results 1.There is no statistically significant difference between different types of thrombus on age,sex,risk factors and so on.2.Percentages of white thrombus,mixed thrombus,red thrombus by HE stain were respectively: 43.9%(36/82),46.3%(38/82),9.8%(8/82).3.Different thrombi types change among different ischemia times,the percent of white thrombi in ≤4h,4-7h,> 7h were: 61.12%(22/36),19.44%(7/36),19.44%(7/36)respectively,P = 0.009;mixed thrombi were: 52.63%(11/38),28.95%(20/38),18.42%(7/38)respectively,P = 0.013;red thrombi were: 37.5%(3/8),37.5%(3/8),25.0%(2/8)respectively,P = 0.895.The difference of distribution of White thrombus and mixed thrombus in ≤4h,4-7h was statistically significant.4.Different thrombi types distribute in INRs,the percent of white thrombi in the LAD,LCX,RCA were: 63.88%(23/36),5.55%(2/36),30.55%(11/36)respectively,P< 0.01;mixed thrombi in LAD,LCX,RCA were: 26.32%(10/38),2.63%(1/38),71.05%(27/38)respectively,P < 0.01;red thrombi in the LAD,LCX,RCA were: 12.50%(1/8),12.50%(1/8),75.00%(6/8)respectively,P > 0.05.The difference of distribution of White thrombus and mixed thrombus in LAD and RCA was statistically significant.5.There are no significantly statistical differences between thrombi types and myocardial perfusion.The percent of TIMI 3 grade in white thrombi,mixed thrombi and red thrombi were: 88.89%,81.58%,62.50% respectively,P> 0.05;MBG 3 grade were: 58.33%,47.36%,37.50% respectively,P> 0.05;c TFC were: 27.75±7.19,31.32±7.98,31.43±6.32 respectively,P> 0.05.6.The cardiac function shows that in white thrombi,mixed thrombi and red thrombi LVEF were: 54.44±6.86 %,54.35±7.34 %,53.55±7.36 % respectively,P> 0.05.LVEDD were: 50.42±4.54 mm,48.50±3.95 mm,46.75±4.42 mm respectively,P> 0.05 in 7 days after PCI.The cardiac function in one year after PCI shows that in white thrombi,mixed thrombi and red thrombi LVEF were: 57.25±5.99 %,55.80±4.34 %,59.5±6.65 % respectively,P> 0.05;LVEDD were: 50.42±4.54 mm,48.50±3.95 mm,46.75±4.42 mm respectively,P> 0.05.There are no significantly statistical differences between thrombi types and cardiac function.7.The incidence rate of MACCE in white thrombi,mixed thrombi and red thrombi were: 3.33%,16.00%,0,P> 0.05 in 1 year after PCI,and there was no significantly statistical differences.Conclusion Different thrombi types distribute in different ischemia times and infarction related artery.Ischemia time and infarction related artery show the predictive value for thrombi types.Cardiovascular interventional doctor select antiplatelet or thrombolysis strategy in the primary PCI by judging the thrombi types depending on ischemia time or IRA,and the prognosis of STEMI patients would be greatly improved. |
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