Pedrini Stella Marinelli, Aloia Thiago P A, Aguillera André H, Gomes Paula M P S, Cade Jamil R, Menezes-Rodrigues Francisco Sandro, Freitas Bárbara P, Souza Marco T, Fonseca Francisco A H, Oliveira Marcos Danillo, Almeida Breno O, Serra Andrey J, Lopes Renato D, Sinigaglia-Coimbra Rita, Caixeta Adriano
Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo 05652-900, Brazil.
Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil.
Biomedicines. 2025 Sep 11;13(9):2235. doi: 10.3390/biomedicines13092235.
: The mechanisms underlying fibrinolysis failure in patients with STEMI who are undergoing a pharmacoinvasive strategy appear to be multifactorial and may be associated with the thrombus's architecture and composition. : We aimed to compare the thrombus composition in patients with STEMI who were undergoing rescue percutaneous coronary intervention (rPCI) versus primary PCI (pPCI) using optical microscopy (OM) and scanning electron microscopy (SEM). Methods: Fifty-three patients were prospectively enrolled, with twenty-five undergoing rPCI and twenty-eight undergoing pPCI. After thrombus aspiration, each harvested fragment was divided into two pieces: one was analyzed using OM with a 60× magnifying lens on hematoxylin-eosin-stained samples, and the other with SEM at 5000× magnification. : Patients who underwent rPCI had significantly higher C-reactive protein levels and a longer ischemic interval at admission compared to those treated with pPCI (9.92 h [range: 1.58-106.17] vs. 2.14 h [range: 0-48]; < 0.001). Optical microscopy analysis revealed that thrombi from rPCI patients exhibited a significantly higher erythrocyte area percentage (18.36% [range: 0.3-50.08] vs. 0.91% [range: 0-70.1]; = 0.001), a lower fibrin content as assessed by optical microscopy (79.49% [range: 49.2-98.25] vs. 94.43% [range: 29.19-99.92]; = 0.006), and a greater amount of cholesterol crystals as measured by SEM (1.73 μm [range: 0-18.51] vs. 0.08 μm [range: 0-0.71]; < 0.001). : The thrombus composition of patients with STEMI who are undergoing rPCI had higher amounts of erythrocytes and cholesterol crystals and a lesser area occupied by fibrin compared to those undergoing pPCI. The composition of thrombi in rPCI could potentially contribute to the failure of fibrinolytic therapy within a pharmacoinvasive strategy.
对于接受药物介入策略的ST段抬高型心肌梗死（STEMI）患者，纤溶失败的潜在机制似乎是多因素的，可能与血栓的结构和组成有关。我们旨在使用光学显微镜（OM）和扫描电子显微镜（SEM）比较接受补救性经皮冠状动脉介入治疗（rPCI）与直接经皮冠状动脉介入治疗（pPCI）的STEMI患者的血栓组成。方法：前瞻性纳入53例患者，其中25例接受rPCI，28例接受pPCI。血栓抽吸后，每个采集的碎片分成两块：一块在苏木精-伊红染色样本上使用60倍放大镜通过OM进行分析，另一块在5000倍放大倍数下通过SEM进行分析。与接受pPCI治疗的患者相比，接受rPCI的患者入院时C反应蛋白水平显著更高，缺血间隔更长（9.92小时[范围：1.58 - 106.17] vs. 2.14小时[范围：0 - 48]；P < 0.001）。光学显微镜分析显示，rPCI患者的血栓红细胞面积百分比显著更高（18.36%[范围：0.3 - 50.08] vs. 0.91%[范围：0 - 70.1]；P = 0.001），通过光学显微镜评估的纤维蛋白含量更低（79.49%[范围：49.2 - 98.25] vs. 94.43%[范围：29.19 - 99.92]；P = 第006），通过SEM测量的胆固醇结晶量更多（1.73微米[范围：0 - 18.51] vs. 0.08微米[范围：0 - 0.71]；P < 0.第001）。与接受pPCI的患者相比，接受rPCI的STEMI患者的血栓组成中红细胞和胆固醇结晶含量更高，纤维蛋白占据的面积更小。rPCI中血栓的组成可能导致药物介入策略中纤溶治疗的失败。
