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Histopathological and scanning electron microscopy analysis of thrombus in patients with ST-segment elevation myocardial infarction

Abstract

Cardiovascular disease is the leading cause of death worldwide, and ST-Segment elevation myocardial infarction (STEMI) is the most prevalent. Primary coronary intervention compared with reperfusion with fibrinolytic therapy reduces major cardiovascular events complications, but few hospitals have catheterization laboratory available to perform the procedure 24 hours a day and 7 days a week. Thus, fibrinolytic therapy is the standard of care pharmacological reperfusion in patients with STEMI, especially in developing countries. However, recent studies have shown that fibrinolysis with tenecteplase fails in approximately 1/3 of the patients with evolving STEMI. The mechanisms that diminish the efficacy of fibrinolysis are still poorly understood, but may be associated with platelet activity, with the presence of procoagulant factors, and thrombus architectural and composition. The present study aims to evaluate the relationship between unsuccessful fibrinolytic therapy and coronary thrombus composition. Thirty STEMI patients will be selected; among them, 15 patients undergoing primary angioplasty and 15 undergoing rescue angioplasty (angioplasty after failed fibrinolysis). Following thrombus aspiration, the harvested fragments will be divided into two fractions, one fraction for scanning electron microscopy analysis and the other fraction by optical microscopy analysis. We will quantify the percentage of cells, particularly platelets, erythrocytes, leukocytes and fibrin by dedicated software. (AU)