Abstract
The purpose of this study was to evaluate intracoronary thrombi in the culprit lesions in patients with acute myocardial infarction (AMI) by angioscopy, and to compare them with clinical and angiographic features. We angioscopically observed the culprit coronary lesions in 66 patients with AMI (55 males and 11 females, 63.9±15.4 years old) just before interventional therapy. Thrombi were observed in 42 of 66 lesions (64%), namely, red thrombi in 16, mixed thrombi in 15, white thrombi in 11. In patients with complete obstruction (TIMI grade 0 and I), red thrombi were more frequently observed than mixed or white thrombi. On the other hand, in patients with incomplete obstruction (TIMI grade II and III), white thrombi were more frequently observed than the others. Angiographically, haziness and filling defect were significantly more frequently observed in patients with red thrombi than the others (p<0.05). The distance from proximal side branch to thrombi tended to be longer in patients with red thrombi than the others. The time from onset of AMI tended to be longer in patients with white thrombi than the others. These results suggest that blood flow may be an important determinant of thrombi characterization.
Highlights
Recent pathological studies revealed that plaque disruption and subsequent local thrombosis were the main clue events in acute myocardial infarction (AMI), resulting in coronary flow reduction and myocardial damages [1]
It was reported that patients with unstable angina were frequently observed to have white thrombi, but none were seen in the patients with AMI, whereas red thrombi were frequently observed in patients with AMI [8]
Thrombi were observed in 42 of 66 lesions (64%), namely, red thrombi in 16, mixed thrombi in 15, white thrombi in 11 (Fig. 1)
Summary
Recent pathological studies revealed that plaque disruption and subsequent local thrombosis were the main clue events in acute myocardial infarction (AMI), resulting in coronary flow reduction and myocardial damages [1]. Several angioscopic observations in patients with AMI had revealed high frequency of plaque disruption and subsequent thrombosis in the coronary lesions [7,8,9,10]. Coronary thrombi observed by angioscopy are classified three types, red, white and mixed thrombi [8,10]. The difference between the mechanism of the formation of white thrombi and that of red thrombi has not been known. To clarify these differences, we angioscopically observed the culprit coronary lesions and compared them with clinical and angiographic features
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