Pathological Characteristics of Aspirated Thrombi From Coronary Artery Embolism in Patients With Acute Myocardial Infarction

Background: The pathological differences in aspirated thrombi between atherosclerotic causes and coronary artery embolism (CE) in patients with acute myocardial infarction (AMI) remain poorly understood. The purpose of this study was to compare the pathological features of aspirated thrombi between AMI patients with CE and those with atherosclerotic causes (non-CE). Methods: We analyzed coronary thrombi retrieved between 2015 and 2019 from 89 consecutive patients presenting with de novo AMI, of whom four had CE and 85 did not. CE was diagnosed based on angiographic and other diagnostic imaging findings. The samples were stained with hematoxylin and eosin (H&E) and elastica-Masson stain (EM). Immunohistochemistry was performed using specific antibodies against CD34 and CD68 to detect endothelial cells and macrophages, respectively. The aspirated thrombi were assessed for their histopathological characteristics. Results: Atrial fibrillation (AF) was more frequently documented in patients with CE than in those with non-CE (100% vs. 9%). The erythrocytes and erythrocytes/total thrombus areas were greater. The prevalence of erythrocyte-dominant thrombi was significantly higher in patients with CE than in those with non-CE (4.94 mm² (3.38-7.35 mm²) vs. 0.62 mm² (0.05-2.51 mm²); 55.6% (50.9-57.7%) vs. 12.6% (2.0-36.2%), P = 0.002; and 75% vs. 7%, P = 0.003, respectively). The age of aspirated thrombi was significantly fresher in CE than in the non-CE (“fresh”: 75% vs. 18%, “lytic”: 25% vs. 28%, and “old”: 0% vs. 54%, respectively). Conclusions: This study suggests that aspirated thrombi derived from patients with AMI due to CE are more erythrocyte-dominant and fresher than those derived from patients with AMI due to atherosclerotic causes. Identifying the etiology of patients with AMI is important because anticoagulation therapy is essential for secondary prevention in patients with CE.

• Publication year

  2025

• Venue

  Cureus

• Publication date

  2025-11-01

• Fields of study

  Medicine

• Identifiers
  DOI 10.7759/cureus.96443PMID 41384164PMCID 12690431
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

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