Intracoronary thrombus age and hospital outcome of patients with acute coronary syndrome with ST segment elevation

摘要

Introduction: Acute ST-elevation myocardial infarction (STEMI) is caused by occlusion of a coronary artery as a result of coronary atherosclerotic plaque disruption and thrombus appearance. Many plaque disruptions are initially covered by mural thrombus without causing clinical symptoms. These mural thrombus may organize over time. Organized mural thiombus may entirely be incorporated in the atherosclerotic lesion maintaining vessel lumen permeable. These so called healed plaque ruptures are found very frequently in coronary arteries at autopsy. In other patients, atherosclerotic plaque disruption with mural thrombosis leads to a process of repeated thrombosis, which ultimately results in an acute coronary syndrome. Kramer et al. described the composition and age of aspirated thiombus in a small cohort of STEMI patients treated with primary percutaneous coronary intervention within 6 hours of onset of symptoms. They demonstrated that in approximately 50% of these STEMI patients, coronary thiombus were days or even weeks old.