Composition of coronary thrombus in acute myocardial infarction.
Composition of coronary thrombus in acute myocardial infarction.
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DOI：
10.1016/j.jacc.2010.09.077
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发表时间：
2011-03-22
影响因子：
24
通讯作者：
Weisel, John W.
中科院分区：
文献类型：
--
作者：
Silvain, Johanne;Collet, Jean-Philippe;Nagaswami, Chandrasekaran;Beygui, Farzin;Edmondson, Kathryn E.;Bellemain-Appaix, Anne;Cayla, Guillaume;Pena, Ana;Brugier, Delphine;Barthelemy, Olivier;Montalescot, Gilles;Weisel, John W.
分析ST段抬高型心肌梗死（STEMI）患者体内冠状动脉血栓的成分。对STEMI患者冠状动脉内血栓形成的动态过程知之甚少。在288例接受直接经皮介入治疗的连续STEMI患者中通过血栓抽吸获得冠状动脉内血栓（n=45），并使用扫描电子显微镜拍摄的高清照片进行分析。同时测定外周血中的血浆生物标志物（TnI、CRPus、IL-6、派-1、sCD 40配体和TNF-α）和血浆纤维蛋白凝块的粘弹性。血栓主要由纤维蛋白（55.9±18%）、血小板（16.8±18%）、红细胞（11.5±9%）、胆固醇结晶（5.2±8.4%）和白细胞（1.3±2.0%）组成。中位缺血时间为175分钟[IQR 140-297]。缺血时间影响血栓成分，导致与冠状动脉内血栓纤维蛋白含量呈正相关，r=0.38，p=0.01，与血小板含量呈负相关，r=-0.34，p=0.02。因此，纤维蛋白含量随着缺血时间增加，范围从48.4±21%（<3小时）增加到66.9±9%（>6小时）（p=0.02），而血小板含量从24.9±23%（<3小时）减少到9.1±6%（>6小时）（p=0.07）。可溶性CD 40配体与血栓中血小板含量呈正相关（r=0.40，p=0.02），与纤维蛋白含量呈负相关（r=-0.36，p=0.04）。多变量分析表明，缺血时间是血栓成分的唯一预测因子，每缺血小时纤维蛋白含量增加2倍（校正OR 2 [1.03-3.7] p=0.01）。在急性STEMI中，闭塞性血栓的血小板和纤维蛋白含量高度依赖于缺血时间，这可能对用于冠状动脉再灌注的药物或器械的疗效产生直接影响。
To analyse composition of coronary thrombus in vivo, in ST-elevation Myocardial Infarction (STEMI) patients. The dynamic process of intracoronary thrombus formation in STEMI patients is poorly understood. Intracoronary thrombi (n=45) were obtained by thromboaspiration in 288 consecutive STEMI patients presenting for primary percutaneous intervention and analyzed using high definition pictures taken with a scanning electron microscope. Plasma biomarkers (TnI, CRPus, IL-6, PAI-1, sCD40 ligand and TNF-α) and plasma fibrin clots viscoelastic properties were measured simultaneously on peripheral blood. Thrombi were mainly composed of fibrin (55.9±18%) with platelets (16.8±18%), erythrocytes (11.5±9%), cholesterol crystal (5.2±8.4%) and leukocytes (1.3±2.0%). The median ischemic time was 175 min [IQR 140-297]. Ischemic time impacted thrombi composition, resulting in a positive correlation with intracoronary thrombus fibrin content, r=0.38, p=0.01 and a negative correlation with platelet content r=-0.34, p=0.02. Thus, fibrin content increased with ischemic time, ranging from 48.4±21% (<3 hours) up to 66.9±9% (>6 hours) (p=0.02), while platelet content decreased from 24.9±23% (<3 hours) to 9.1±6% (>6 hours) (p=0.07). Soluble CD40 ligand was positively correlated to platelet content in the thrombus (r=0.40, p=0.02) and negatively correlated with fibrin content (r=-0.36; p=0.04). Multivariate analysis indicated that ischemic time was the only predictor of thrombus composition with a 2-fold increase of fibrin-content per ischemic hour (adjusted OR2 [1.03-3.7] p=0.01). In acute STEMI, platelet and fibrin contents of the occlusive thrombus are highly dependent of ischemic time, which may have a direct impact on the efficacy of drugs or devices used for coronary reperfusion.
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影响因子：
2.4
作者：
Sim, DS;Flaumenhaft, R;Furie, B
通讯作者：
Furie, B
DOI：
10.1161/01.atv.0000241589.52950.4c
发表时间：
2006-11-01
影响因子：
8.7
作者：
Collet, J. P.;Allali, Y.;Montalescot, G.
通讯作者：
Montalescot, G.
影响因子：
39.3
作者：
Bavry, Anthony A.;Kumbhani, Dharam J.;Bhatt, Deepak L.
通讯作者：
Bhatt, Deepak L.
影响因子：
2.7
作者：
Collins, Tony J.
通讯作者：
Collins, Tony J.
DOI：
10.1046/j.1365-2818.1997.1940755.x
发表时间：
1997-04-01
期刊：
JOURNAL OF MICROSCOPY-OXFORD
影响因子：
--
作者：
Braet, F;deZanger, R;Wisse, E
通讯作者：
Wisse, E