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

Jaroslaw Zalewski; Jan Bogaert; Marcin Sadowski; Olga Woznicka; Konstantinos Doulaptsis; Maria Ntoumpanaki; Michal Zabczyk; Jadwiga Nessler; Anetta Undas

doi:10.1160/TH14-09-0801

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2015; 113(06): 1258-1269
DOI: 10.1160/TH14-09-0801

Coagulation and Fibrinolysis

Schattauer GmbH

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

Jaroslaw Zalewski

¹Department of Coronary Heart Disease, Jagiellonian University, Krakow, Poland

,

Jan Bogaert

²Department of Radiology, UZ Leuven, Translational MRI, Department of Imaging & Pathology, KU Leuven, Belgium

,

Marcin Sadowski

³Department of Cardiology, Swietokrzyskie Cardiology Centre, Kielce, Poland

,

Olga Woznicka

⁴Department of Cell Biology and Imaging, Faculty of Biology and Earth Sciences, Jagiellonian University, Krakow, Poland

,

Konstantinos Doulaptsis

²Department of Radiology, UZ Leuven, Translational MRI, Department of Imaging & Pathology, KU Leuven, Belgium

,

Maria Ntoumpanaki

²Department of Radiology, UZ Leuven, Translational MRI, Department of Imaging & Pathology, KU Leuven, Belgium

,

Michal Zabczyk

⁵Department of Experimental Cardiac Surgery, Anestesiology and Cardiology, Institute of Cardiology, Jagiellonian University, Krakow, Poland

,

Jadwiga Nessler

¹Department of Coronary Heart Disease, Jagiellonian University, Krakow, Poland

,

Anetta Undas

⁵Department of Experimental Cardiac Surgery, Anestesiology and Cardiology, Institute of Cardiology, Jagiellonian University, Krakow, Poland

› Author Affiliations

Abstract

summary

Determinants 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 (K_s), which indicates the average pore size, lysis time (t_{50 %}), platelet reactivity index (PRI) and ADP-induced platelet aggregation (ADP_5,20μM) 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 K_s (r≤-0.55, P< 0.0001) and t_50% (r≥ 0.29, P≤ 0.02) but not with PRI and ADP_5,20μM. 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 K_s or t_50%. By multivariate regression, K_s (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.

Keywords

Myocardial infarction - coronary thrombosis - fibrin - platelets - scanning electron microscopy

Full Text

References

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