Intracoronary Thrombus Research Articles

Manual thrombus aspiration during percutaneous coronary intervention: Cherish as “Blessing of Thanksgiving” in a case of spontaneous coronary artery dissection presenting with large intracoronary thrombus burden

Manual thrombus aspiration during percutaneous coronary intervention: Cherish as “Blessing of Thanksgiving” in a case of spontaneous coronary artery dissection presenting with large intracoronary thrombus burden

D-Dimer to Creatinine Ratio (DCR) and Intracoronary Thrombus Burden as Risk Factors for Hospitalized Major Cardiovascular Events (MACE) in Patients with ST Elevation Myocardial Infarction (STEMI)

Background: STEMI pathophysiology is based on increased activity of coagulation, thrombosis, and inflammation. The role of STEMI biomarkers is essential for prognostic and risk stratification. Dimer-Creatinine Ratio (DCR) is a novel biomarker that could be combined with intracoronary thrombus burden according to TIMI Thrombus Grade to evaluate in hospital MACE in STEMI patients. Methods: A cohort prospective design was implemented in this study, with subjects of STEMI patients undergoing primary PCI. Low and high DCR values were determined by the ROC curve. Survival analysis with the Kaplan-Meier curve was used to evaluate MACE outcome according to DCR and intracoronary thrombus burden. Multivariate analysis Cox regression and stratification analysis were used to evaluate independent risk factors, the relationship of each variable, and in hospital MACE. Results: A total of 60 samples were included, 40 patients (66.7%) with high DCR and 36 patients (60%) with high intracoronary thrombus burden. 36 (59.8%) patients were known to have in hospital MACE. Cut-off point was used to determine high DCR was 1.51 (AUC 0.905; 95%CI: 0.825-0.989; p<0.001). Cox regression model backward log rank showed high DCR (adjusted HR 20.81; 95%CI: 2.18-98.16; p=0.007) and high intracoronary thrombus burden (adjusted HR 31.38; 95%CI: 4.51-89.15; p=0.017), smoking (adjusted HR 2.70; 95% CI 0.88-3.29; p=0.012), and diabetes mellitus (adjusted HR 7.55; 95% CI 1.13-11.58; p=0.035) played a role as independent risk factors of in-hospital MACE in STEMI patients. A combination of both high DCR and high intracoronary thrombus burden had a higher incidence of 91.2% of in hospital MACE according to stratification analysis (Mantel-Haenzel Common Estimate 14.33; Breslow-Day Homogeneity p=0.803; Cochran’s and Mantel-Haenszel p=<0.013). Conclusion: High DCR and high intracoronary thrombus burden can be used as additional information for risk stratification of in hospital MACE in STEMI patients, especially when both parameters are combined.

Platelet Indices and Intracoronary Thrombus Grade as Predictors of In-Hospital Major Cardiovascular Events in Patients with ST Elevation Myocardial Infarction Post Primary Percutaneous Coronary Intervention

Background: The high mortality rate of ST Elevation Myocardial Infarction (STEMI) is caused by its complications, especially in-hospital major cardiovascular events (MACE). This study aims to determine the relationship between platelet indices and intracoronary thrombus grade as predictors of in-hospital MACE and the interaction of the combination of both predictors in patients with STEMI post-primary percutaneous coronary intervention (PCI). Methods: This prospective cohort study was conducted with STEMI patients who underwent primary PCI. Data was analyzed by SPSS 24.0.0.0 version. Results: There were 71 samples: 46 patients (64.8%) with a high platelet index and 48 patients (67.6%) with a high intracoronary thrombus grade. During in-hospital follow-up, there were found that 42 patients (59.2%) experienced MACE. The cut-off value used classifies high platelet index for PDW 11.25 fl (AUC 0.892; CI 95% 0.786-0.999; p<0.001) and MPV 10.15 (AUC 0.901; CI 95% 0.812-0.990; p<0.001). The Cox regression backward log-rank model showed both high platelet indices (adjusted HR 38.13; CI 95% 5.16-282.03; p<0.001) and high Intracoronary Thrombus Grade (adjusted HR 31.67; CI 95% 4.28-234.54; p=0.001) played an independent role as predictors of MACE during hospitalization, regardless of the influence of coronary angiography results, Killip class, smoking and consumption of acetosal and clopidogrel. The combination of two predictors of high platelet indices and high Intracoronary Thrombus Grade based on SEM analysis showed that 95.2% experienced in-hospital MACE (Mantel-Haenzel Common Estimate 17.48; Breslow-Day Homogeneity p=0.772; Cochran’s and Mantel-Haenszel p=<0.001), had better predictive ability as seen from the comparison of the respective AUC values, namely the combination, high platelet indices and high Intracoronary Thrombus Grade (0.942; 0.902; 0.873; p<0.001). Conclusion: High platelet indices and high intracoronary thrombus grade can be used as additional information for risk stratification of in-hospital MACE of STEMI patients post-primary PCI, especially when both variables were combined.

Prevalence of coronary artery anomalies in young sudden cardiac death: insights from a prospective state-wide registry

Abstract Background Coronary artery anomalies (CAAs) have been previously implicated as a major cause of young sudden cardiac death (SCD), particularly in exercise-related SCD with a reported prevalence of up to 33%. Methods A state-wide prospective out-of-hospital cardiac arrest registry identified all patients aged 1–50 years who experienced an SCD and underwent autopsy from April 2019 to April 2021. Rates of normal anatomy, normal variants and CAAs were identified and circumstances and cause of death for patients with CAAs examined. Results Of 1,477 patients who experienced cardiac arrest during the study period, 490 underwent autopsy and were confirmed to have experienced SCD. Of these 490 patients, five (1.0%) had a CAA identified with three having anomalies of coronary origin and two having anomalies of coronary course. In no cases was the CAA deemed responsible for the SCD. In two cases, severe coronary disease and intra-coronary thrombus with histological evidence of acute myocardial infarction were identified, in the third critical coronary disease was found, the fourth had an unrelated thoracic aortic dissection and the fifth had cardiomegaly in the setting of illicit drug use. Of 27 patients who experienced their SCD during exercise, only one had a CAA identified (the patient with thoracic aortic dissection). Conclusion In this prospective cohort of consecutive young patients with SCD who underwent autopsy, CAAs occurred in 1.0% of patients and did not cause any deaths. The role of CAAs in causing young SCD appears to be less significant than previously hypothesised. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): NHMRC, NHF

Management of no Reflow during Percutaneous Transcoronary Angioplasty with Catheter-Directed Intracoronary Thrombolysis: A Retrospective Observational Study.

Intracoronary thrombus is common in patients with ST-elevation myocardial infarction (STEMI). Percutaneous coronary intervention (PCI) is the treatment of choice for these patients. Intracoronary thrombus is still a challenge during PCI in STEMI, even with dual antiplatelets, glycoprotein IIb/IIIa inhibitor, and anticoagulation. Intracoronary thrombus can cause distal or nonculprit vessel embolization and no-reflow state. No reflow results in large infarct size, adverse left ventricular remodeling, arrhythmias, and death. Recently, catheter-directed intracoronary thrombolysis (ICT) is gaining acceptance in patients with no-reflow due to a large thrombus burden. Evaluation of catheter-directed ICT in patients with acute STEMI who develop no reflow due to large thrombus burden during PCI. This was a retrospective observational study conducted after approval of the institutional ethics committee in a tertiary care hospital of north India from April 15, 2021 to April 14, 2022, included 1020 adult patients who had undergone coronary evaluation. 37.25% patients had PCI, among these 10% had PCI for acute STEMI. Thrombolysis in myocardial infarction (TIMI) Grade 5 in 79.17% and Grade 4 in 20.83%. ICT was done with low-dose tenecteplase (15 ± 5 mg). The TIMI flow III in 91.67% and II in 8.33% of patients was achieved after intracoronary thrombolysis. Major risk factor was tobacco smoking in 41.67%, and the major complication was left ventricular failure in 33.33%. Catheter-directed ICT is safe and effective in reducing thrombus burden, thus improving myocardial reperfusion in STEMI. This condition has a grave prognosis and can lead to adverse cardiac outcomes. There are many drugs that have been tried to manage no reflow. The use of ICT to treat no-reflow state can be life saving with minimal systemic side effects.

The relationship between intracoronary thrombus burden and atherogenic index in patients with ST-elevation myocardial infarction.

Increased coronary thrombus load is a strong predictor of adverse cardiovascular (CV) outcomes. Identifying predictors of intracoronary thrombus burden may contribute to the management of ST-segment elevation myocardial infarction (STEMI). We aimed at evaluating the relationship between the atherogenic index (ATI) and coronary thrombus burden in patients presenting with STEMI. 139 patients who presented with STEMI and underwent primary percutaneous coronary intervention were included in this study. Angiographic thrombus burden was classified as previously defined in the myocardial infarction (TIMI) study group. The patients were divided into two groups as those with high and low thrombus load. Independent predictors of high thrombus burden were ATI (OR: 4.23, 95% CI: 2.38-7.5; p<0.001), serum creatinine level (OR: 17.4, 95% CI: 3.03-101.4; p=0.001) and non-LAD involvement (OR: 0.363, 95% CI: 0.14-0.92; p=0.034). The association of ATI with thrombus load was independent from HDL and TGL levels. The atherogenic index can be used as a reliable marker for increased coronary thrombus burden, which is associated with adverse CV outcomes.

Outcomes of thrombus aspiration during primary percutaneous coronary intervention for ST-elevation myocardial infarction.

Previous large multi-centre randomised controlled trials have not provided clear benefit with routine intracoronary thrombus aspiration (TA) as an adjunct to primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI). To determine whether there is a difference in outcomes with the use of manual TA prior to PCI, compared with PCI alone in a cohort of patients with STEMI. We analysed data from 6270 consecutive patients undergoing primary PCI for STEMI prospectively enrolled in the Melbourne Interventional Group registry between 2007 and 2018. Multivariable analysis was performed to determine predictors of 30-day major adverse cardiovascular and cerebrovascular events (MACCE) and long-term mortality. We compared 1621 (26%) patients undergoing primary PCI with TA to 4649 (74%) patients undergoing PCI alone. Male gender (81% vs 78%; P < 0.01), younger age (61 vs 63 years; P = 0.03), GP-IIb/IIIa use (76% vs 58%, P < 0.01), and current smoking (40% vs 36%; P < 0.01) were more common in the TA group. TA was more likely to be used in patients with complex lesions (83% vs 66%; P < 0.01) with TIMI 0 flow (77% vs 56%; P < 0.01). No significant difference in post-procedural TIMI flow, stroke, 30-day mortality, or long-term mortality were identified. Multivariable analysis demonstrated a reduction in 30-day MACCE (hazard ratio (HR) 0.75; confidence interval (CI) 0.63-0.89; P < 0.01) in the TA group, but was not associated with long-term mortality (HR 0.98; CI 0.85-1.1; P = 0.73). The use of TA in patients undergoing primary PCI for STEMI was not associated with improved short or long-term mortality when compared with PCI alone.

Circulating Microvesicles in Association with the NLRP3 Inflammasome in Coronary Thrombi from STEMI Patients.

Microvesicles (MVs) are actively secreted by cells. The NLRP3-inflammasome and the interleukin 6 (IL-6)-pathways are central in cardiovascular disease. Knowledge of how the inflammasome influences the MVs is limited. In a cross-sectional study, we assessed whether MVs in plasma associate with genes encoding inflammasome signalling in coronary thrombi. Moreover, any relationships between inflammasome activation and phosphatidylserine (PS) externalization, determined through Annexin V (AV+) labelling, and myocardial injury, assessed by cardiac troponin T (cTnT), were analysed. Intracoronary thrombi and blood samples from STEMI patients (n = 33) were investigated. mRNA of NLRP3, caspase-1, interleukin-1β (IL-1β), interleukin-18 (IL-18), IL-6, soluble IL-6-receptor (sIL-6R), and glycoprotein-130 (gp130) were isolated from the thrombi and relatively quantified by RT-PCR. MVs were analysed by flow cytometry. Total AV+ MVs, mainly reflecting hypercoagulability, correlated positively to NLRP3 gene expression (r = 0.545, p = 0.009). A similar pattern was seen for platelet, endothelial and leukocyte derived MVs, separately. The majority of the MVs were AV− (96%). Total and AV− MVs correlated inversely with IL-1β (r = −0.399 and −0.438, respectively, p < 0.05, both) and gp130 (r = −0.457 and −0.502, respectively, p < 0.05, both). No correlations between MVs and cTnT were observed. Our findings indicate an association between NLRP3-inflammasome in coronary thrombi and procoagulant AV+ MVs in STEMI patients. The inverse relationships between AV− MVs and the gene expression of inflammasome activation may indicate an immuno-dampening role of this subpopulation.

Well-Developed Coronary Collateral Circulation Is Associated With Higher Thrombus Burden in the Setting of ST-Segment Elevation Myocardial Infarction.

This study investigated the relationship between coronary collateral circulation (CCC) and intracoronary thrombus burden in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI). CCC and thrombus burden are predictive of clinical outcomes in patients with STEMI. Patients with STEMI undergoing primary percutaneous coronary intervention were enrolled (n = 172). CCC was graded according to the Cohen-Rentrop classification. Patients were classified as insufficient (grade 0 or 1, n = 134) or well-developed (grade 2 or 3; n = 38) CCC. The Thrombolysis in Myocardial Infarction scale was used to evaluate intra-coronary thrombus burden. The low-thrombus-burden group comprised those with grades 0 to 2, and the high-thrombus-burden group comprised those with grades 3 or 4. Right coronary artery infarcts had a 13.830-fold higher chance of having well-developed CCC than did left anterior descending artery infarcts (P &lt; .001). Circumflex artery infarcts had a 7.904-fold higher chance of well-developed CCC than did left anterior descending artery infarcts (P = .016). High thrombus burden was associated with a 4.393-fold higher chance for well-developed CCC than was low thrombus burden (P = .030). Low albumin levels were related to a greater chance of having well-developed CCC (P = .046). Patients with well-developed CCC have higher thrombus burden than do those with insufficient CCC. Because well-developed CCC is an indicator of more severe underlying lesions, we speculate that patients with severe lesions are more prone to experience more complicated STEMI with high thrombus burden.

Association of stress induced hyperglycemia with angiographic findings and clinical outcomes in patients with ST-elevation myocardial infarction

BackgroundStress induced hyperglycemia (SIH) is common among patients with ST-elevation myocardial infarction (STEMI), even in patients without diabetes mellitus. However, evidence regarding its role on the angiographic outcomes and the prognosis of patients presenting with STEMI is scarce.MethodsThis study included 309 consecutively enrolled STEMI patients undergoing primary percutaneous coronary intervention (pPCI). Patients were diagnosed with SIH if blood glucose on admission was > 140 mg/dl. Also, patients had to fast for at least 8 hours before blood sampling. The objective was to assess whether SIH was associated with major adverse cardiovascular and cerebrovascular (MACCE) events and explore its relationship with angiographic predictors of worse prognosis such as poor initial TIMI flow, intracoronary thrombus burden, distal embolization, and presence of residual thrombus after pPCI.ResultsSIH in diabetic and non-diabetic patients was associated with a higher incidence of LTB (aOR = 2.171, 95% CI 1.27–3.71), distal embolization (aOR = 2.71, 95% CI 1.51–4.86), and pre-procedural TIMI flow grade = 0 (aOR = 2.69, 95% CI 1.43–5.04) after adjusting for relevant clinical variables. Importantly, during a median follow-up of 1.7 years STEMI patients with SIH with or without diabetes experienced increased occurrence of MACCE both in univariate (HR = 1.92, 95% CI 1.19–3.01) and multivariate analysis (aHR = 1.802, 95% CI 1.01–3.21).ConclusionsSIH in STEMI patients with or without diabetes was independently associated with increased MACCE. This could be attributed to the fact that SIH was strongly correlated with poor pre-procedural TIMI flow, LTB, and distal embolization. Large clinical trials need to validate SIH as an independent predictor of adverse angiographic and clinical outcomes to provide optimal individualized care for patients with STEMI.

Intracoronary Thrombus in a Patient with Elevated Lp(a) Levels and COVID-19

Lead Author's Financial DisclosuresNothing to disclose.Study FundingNone.Background/SynopsisLp(a) is elevated in 20% of the population and is associated with increased risk for myocardial infarctions and strokes. In patients with COVID-19, Lp(a) is upregulated as a response to the systemic inflammatory infection which can potentially increase the risk for atherothrombotic events. The following case presents the first report of a patient with elevated Lp(a) levels and COVID-19 who presented with an acute MI and evidence for intracoronary thrombus.Objective/Purpose49-year-old male with past medical history of thoracic aortic aneurysm recently diagnosed with COVID-19 presented to ED with chest pain. EKG showed ST-segment elevation in the anterior leads with a 12.7 troponin score. Patient underwent emergent cardiac catheterization that showed 90% ulcerated thrombotic lesion in the proximal LAD. The thrombus was demonstrated by both angiography and IVUS. Thrombectomy, angioplasty, and stenting were performed. There was embolization of thrombus to the distal LAD. Echocardiogram revealed LVEF 55% with apical hypokinesis. He was started on DAPT, statin, and rivaroxaban due to the high risk of recurrent coronary thrombosis. His Lp(a) was 200 nmol/L. (Normal < 75 nmol/L).MethodsN/A.ResultsCases of patients with COVID-19 and elevated Lp(a) presenting with acute MI and intracoronary thrombus have yet to be reported. Elevated Lp(a) level is thought to increase the risk of cardiovascular events and venous thromboembolism through anti-fibrinolytic and pro- atherosclerotic properties. Acute, transient elevations in Lp(a) secondary to IL-6 production have been observed in inflammatory states, such as COVID-19 infections. A cohort study of 146 COVID-19 patients in the Netherlands observed a mean increase in Lp(a) of 16.9mg/dL from baseline over a course of 21 days during hospitalization In a retrospective study of patients admitted with COVID-19, 5.6% of 531 experienced arterial thrombosis, 9 of which suffered myocardial infarction. In patients similar to ours with COVID- 19 and elevated Lp(a), there may be elevated risk of similar events and providers should remain vigilant for potential complications. It is possible that acutely elevated Lp(a) levels contribute to arterial thrombotic events in the coronaries during COVID-19 infection.ConclusionsIn patients presenting with COVID-19 and acute myocardial infarction, we recommend that clinicians measure Lp(a) level and evaluate for intracoronary thrombi to correlate our findings.

Intracoronary thrombus visualized by optical coherence tomography in a patient with antiphospholipid syndrome

Abstract A patient with a history of deep venous thrombosis on warfarin underwent coronary angiography and was found to have a red intracoronary thrombus in the mid left anterior descending artery by optical coherence tomography. Percutaneous coronary intervention was successfully performed. On discharge, the patient continued triple therapy with aspirin, clopidogrel, and apixaban for 30 days then discontinued aspirin. A hypercoagulable work up was notable for antiphospholipid syndrome and lifelong anticoagulation was recommended. The patient continued apixaban twice daily given recurrent thrombosis while on warfarin and was event free at 6-month follow up.

Outcome of Intracoronary Tirofiban administration at Primary Percutaneous Coronary Intervention in St-Elevation Myocardial Infarction Patients

Background: ST-elevation myocardial infarction results from obstruction of coronary flow due to intracoronary thrombus formation. Primary PCI is the gold standard and class-I indication for revascularization following STEMI. Investigators in this study aimed to evaluate the TIMI flow and myocardial blush grade after intracoronary Tirofiban administration in patients with STEMI during the primary percutaneous coronary intervention (PPCI) and its outcome.&#x0D; Methodology: This Cohort study was conducted at Cardiology Department, Niazi Medical &amp; Dental College, Sargodha, after getting informed consent from patients with STEMI. Primary PCI was done in these patients, and two groups were formed. Tirofiban and Non-tirofiban group on basis of Tirofiban administration. Variables included TIMI Grade flow, myocardial blush, major bleeding, minor bleeding, hematoma, MACE, and mortality. P&lt;0.05 was considered statistically significant.&#x0D; Results: The mean age of the study groups was 41.64 ± 12.30 years, with 74% (N=250) males. It was seen that 39 (31.2%) vs 41 (32.8%) with p-value of 0.786 were hypertensive, 28 (22.4%) vs 34 (27.2%) diabetic were having p-value of 0.380 whereas 34 (27.2%) vs 37 (29.6%) with p-value of 0.674 were smokers. TIMI flow grades in both groups were not similar and showed significant differences, indicating that both groups were independent, with a p-value &lt;0.05. The myocardial blush grade was compared in the two groups and the results showed that the score in both the groups was not similar, having significant differences as the p-value was 0.001; major bleeding compared with minor showed statistical insignificance, which indicated that there is a relationship between the two groups. (p-value=0.625 &amp; 0.705 respectively).&#x0D; Conclusion: Administration of intracoronary Tirofiban was associated with superior clinical prognosis in terms of TIMI flow and myocardial blush grades compared with the other group at primary PCI.

Immunohistochemical characteristics of coronary thrombi in ST-elevation myocardial infarction

Background and aimsThe dynamics and implications of intracoronary thrombus constituency in patients with ST-segment elevation myocardial infarction (STEMI) are not fully understood. We evaluated the expression of CD34, CD61and factor VIII surface markers in thrombi of patients with STEMI and its association with clinical and angiographic characteristics and major adverse cardiovascular events (MACE). MethodsPatients presenting with STEMI undergoing aspiration thrombectomy during primary percutaneous coronary intervention (pPCI) were included. Morphological, histopathological and immunohistochemical aspects of thrombi were assessed by two pathologists blinded to clinical variables and outcomes. ResultsThe mean age of the 245 patients included was 58 ± 12 years old, and 70 % were men. Regarding the thrombi microscopic patterns, 61 % were classified as recent, 20 % as lytic and 19 % as organized. There were higher levels of the CD61 index in patients with a history of heart failure. Smokers presented lower CD61 positive cells and CD61 index, but this association did not remain significant after multivariable analysis. There was an inverse correlation between CD61 positive cells and CD61 index with the time from onset of pain to the first medical contact, but no other significant association amongst clinical characteristics and antigenic expression. There was higher expression of the CD61 antigen in patients with in-hospital MACE, but statistical significance was borderline (p = 0.06). ConclusionsIn this cohort of patients with STEMI, immunohistochemistry of coronary thrombus showed a significantly higher platelet content in patients with previous heart failure and a trend in those with in-hospital MACE. Thrombus' platelet content was inversely related to ischemic time.

Patterns of intracoronary thrombus by high-definition intravascular ultrasound.

Patterns of intracoronary thrombus by high-definition intravascular ultrasound.

Prevalence of Coronary Artery Anomalies in Young and Middle-Aged Sudden Cardiac Death Victims (from a Prospective State-Wide Registry)

Coronary artery anomalies (CAAs) have been previously implicated as a major cause of young sudden cardiac death (SCD), particularly in exercise-related SCD, with a prevalence of up to 33%. A state-wide prospective out-of-hospital cardiac arrest registry identified all patients aged 1 to 50years who experienced an SCD and underwent autopsy from April 2019 to April 2021. Rates of normal anatomy, normal variants, and CAAs were identified, and circumstances and causes of death for patients with CAAs examined. Of 1,477 patients who experienced cardiac arrest during the study period, 490 underwent autopsy and were confirmed to have experienced SCD. Of these 490 patients, 5 (1%) had a CAA identified, with 3 having anomalies of coronary origin and 2 having anomalies of coronary course. In no cases were the CAA deemed responsible for the SCD. In 2 cases, severe coronary disease and intra-coronary thrombus with histological evidence of acute myocardial infarction were identified. In the third, critical coronary disease was found, the fourth had an unrelated thoracic aortic dissection, and the fifth had cardiomegaly in the setting of illicit drug use. Of 27 patients who experienced their SCD during exercise, only 1 had a CAA identified (the patient with thoracic aortic dissection). In conclusion, in this prospective cohort of consecutive young patients with SCD who underwent autopsy, CAAs occurred in 1% of patients and did not cause any deaths. The role of CAAs in causing young and middle-aged SCD appears to be less significant than previously hypothesized.

Pathophysiology and mechanisms of Acute Coronary Syndromes: athero-thrombosis, immune-inflammation and beyond

Introduction The pathophysiology of atherosclerosis and its acute complications, such as the Acute Coronary Syndromes (ACS), is continuously under investigation. Immunity and inflammation seem to play a pivotal role in promoting formation and grow of atherosclerotic plaques. At the same time, plaque rupture followed by both platelets’ activation and coagulation cascade induction lead to intracoronary thrombus formation. Although these phenomena might be considered responsible of about 90% of ACS, in up to 5-10% of acute syndromes a non-obstructive coronary artery disease (MINOCA) might be documented. This paper gives an overview on athero-thrombosis and immuno-inflammation processes involved in ACS pathophysiology also emphasizing the pathological mechanisms potentially involved in MINOCA. Areas Covered The relationship between immuno-inflammation and atherothrombosis is continuously updated by recent findings. At the same time, pathophysiology of MINOCA still remains a partially unexplored field, stimulating the research of potential links between these two aspects of ACS pathophysiology. Expert opinion Pathophysyiology of ACS has been extensively investigated; however, several grey areas still remain. MINOCA represents one of these areas. At the same time, many aspects of immune-inflammation processes are still unknown. Thus, research should be continued to shed a brighter light on both these sides of “ACS” moon.

Co-relation of Monocyte Count in High vs. Low Thrombus Burden ST-Segment Elevated Myocardial Infarction (STEMI) Patients Undergoing Primary Percutaneous Coronary Intervention.

IntroductionPrimary percutaneous coronary intervention (PPCI) in ST-elevation myocardial infarction (STEMI) patients can lead to poor outcomes. Intra-coronary thrombus development due to atherosclerotic plaque rupture and coronary blood flow blockage causes STEMI. Intracranial thrombosis in STEMI patients is fatal.It was our goal to establish how often patients with STEMI underwent PPCI with a high thrombus burden versus a low thrombus burden and to compare the mean monocyte count between the two groups.Material and methodsThis cross-sectional study was conducted at KRL Hospital Islamabad from October 2021 to March 2022. At a 95% level of confidence, a 5% margin of error, and keeping a population size of 330, a sample size of 178 was obtained using the Raosoft sample size calculator (Raosoft, Inc., Seattle, WA). The non-probability consecutive sampling method was used.All patients with STEMI undergoing PPCI, aged between 18 and 80 years, and presenting within 24 hours of symptoms were included in our study. Pre-PPCI pharmacological treatment given within three hours of the onset of a heart attack to stabilize patients with myocardial infarction included aspirin, clopidogrel, and an intravenous bolus of 70 U/kg of body weight of un-fractionated heparin. The collected data were analyzed using SPSS version 26.0 (IBM Corp., Armonk, NY). Fisher's exact test was employed, and a p-value of less than 0.05 was deemed statistically significant. The odds ratio and confidence interval were also calculated.ResultsA total of 178 participants were included in the research, out of which males were predominant with more than half of the study population. The mean age in patients having a low thrombus burden was 37.75 ± 6.39 years and that of patients with a high thrombus burden was mean 56.04 ± 7.98 years. In high thrombus burden patients, diabetes mellitus was found in 98.3%, hypertension in 120 patients (100%), obesity in (60%), and tobacco consumption in 120 patients (100%). The mean monocyte count in high burden patients was 70.27 ± 3.24, whereas it was 61.89 ± 5.71 in low burden patients. Only five patients had a Thrombolysis In Myocardial Infarction (TIMI) score of 5 while 34.8% of patients arrived in three to six hours and 12.9% arrived in less than three hours. Patients with a high monocyte count have 1.3 times more chances of developing the disease when the monocyte count was high (OR = 1.318, 95% CI = 1.140-1.524).ConclusionPatients with STEMI undergoing PPCI had a higher monocyte count upon admission, which was an independent clinical predictor of a high thrombus burden. Our findings suggest that admission monocyte count may be available for early risk stratification of high-thrombus burden in acute STEMI patients and might allow the optimization of anti-thrombotic therapy to improve the outcomes of PPCI.

High expression of SGK1 in thrombosis of acute ST-segment elevation myocardial infarction: Based on proteomics analysis of intracoronary thrombosis

Introduction and objectivesThrombosis is involved in the onset and progression of ST-segment elevation myocardial infarction (STEMI). The aim of this study was to explore the expression level of serum- and glucocorticoid-inducible kinase 1 (SGK1) in intracoronary thrombus and the relationship between them. MethodsWe identified 30 patients who received treatment in the Affiliated Hospital of Hangzhou Normal University between May 2018 to May 2020 and who underwent thrombus aspiration and percutaneous coronary intervention for ST-segment-elevation myocardial infarction. Additionally, we selected 30 patients with normal coronary angiography for the control group. We analyzed thrombus protein expression profiling by combining tandem mass tag labeling, high-performance liquid chromatography fractionation and mass spectrometry quantification approach. ResultsThe differentially regulated protein profiles revealed the alteration of serine-threonine/tyrosine-protein kinase, which was upregulated significantly in the experimental group. We selected SGK1 downstream factor for validation and found that the expression of SGK1 in the thrombus of STEMI was significantly increased. Immunohistochemistry (IHC) showed significantly increased expression of SGK1 in the thrombus of STEMI patients compared with the control group (17.21±2.36 vs. 4.14±1.17%, p<0.05). Similar findings were observed in the Western blot analysis (p<0.05). IHC showed that SGK1 expressed in a region similar to that of the platelets. ConclusionThis is the first quantitative proteomics study to assess thrombus in patients with STEMI. The expression of SGK1 in thrombus was significantly higher in patients with acute STEMI than in the control group. SGK1 might be involved in the platelet physiological process.

Abciximab-induced thrombocytopenia: Correct management

Thrombocytopenia is a possible side effect of routinely administered medical agents. Abciximab is one of the three potent intravenous glycoprotein IIb/IIIa receptor inhibitors (along with eptifibatide and tirofiban) that have shown significant positive outcomes when used in patients with intracoronary thrombus. The use of abciximab was associated with the risk of thrombocytopenia. This case reported the development of thrombocytopenia and treatment management after using abciximab.