scholarly journals Microthrombi As A Major Cause of Cardiac Injury in COVID-19: A Pathologic Study

Circulation ◽  
2021 ◽  
Author(s):  
Dario Pellegrini ◽  
Rika Kawakami ◽  
Giulio Guagliumi ◽  
Atsushi Sakamoto ◽  
Kenji Kawai ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Cardiac Injury ◽  
Myocardial Damage ◽  
Coronary Intervention ◽  
Hospitalized Patients ◽  
Cross Sectional ◽  
St Segment Elevation ◽  
Pathologic Analysis ◽  
Underlying Mechanisms

Background: Cardiac injury is common in hospitalized patients with COVID-19 and portends poorer prognosis. However, the mechanism and the type of myocardial damage associated with SARS-CoV-2 remain uncertain. Methods: We conducted a systematic pathologic analysis of 40 hearts from hospitalized patients dying of Coronavirus Disease 2019 (COVID-19) in Bergamo, Italy to determine the pathologic mechanisms of cardiac injury. We divided the hearts according to presence or absence of acute myocyte necrosis and then determined the underlying mechanisms of cardiac injury. Results: Of the 40 hearts examined, 14 (35%) had evidence of myocyte necrosis, predominantly of the left ventricle. As compared to subjects without necrosis, subjects with necrosis tended to be female, have chronic kidney disease, and shorter symptom onset to admission. The incidence of severe coronary artery disease (i.e., >75% cross sectional narrowing) was not significantly different between those with and without necrosis. 3/14 (21 .4%) subjects with myocyte necrosis showed evidence of acute myocardial infarction defined as ≥1 cm 2 area of necrosis while 11/14 (78.6%) showed evidence of focal (> 20 necrotic myocytes with an area of ≥ 0.05 mm 2 but <1 cm 2 ) myocyte necrosis. Cardiac thrombi were present in 11/14 (78.6%) cases with necrosis, with 2/14 (14.2%) having epicardial coronary artery thrombi while 9/14 (64.3%) had microthrombi in myocardial capillaries, arterioles, and small muscular arteries. We compared cardiac microthrombi from COVID-19 positive autopsy cases to intramyocardial thromboemboli from COVID-19 cases as well as to aspirated thrombi obtained during primary percutaneous coronary intervention from uninfected and COVID-19 infected patients presenting with ST-segment elevation myocardial infarction (STEMI). Microthrombi had significantly greater fibrin and terminal complement C5b-9 immunostaining as compared to intramyocardial thromboemboli from COVID-19 negative subjects and to aspirated thrombi. There were no significant differences between the constituents of thrombi aspirated from COVID-19 positive and negative STEMI patients. Conclusions: The most common pathologic cause of myocyte necrosis was microthrombi. Microthrombi were different in composition as compared to intramyocardial thromboemboli from COVID-19 negative subjects and to coronary thrombi retrieved from COVID-19 positive and negative STEMI patients. Tailored anti-thrombotic strategies may be useful to counteract the cardiac effects of COVID-19 infection.

scholarly journals ST Elevation Infarction after Heart Transplantation Induced by Coronary Spasms and Mural Thrombus Detected by Optical Coherence Tomography

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Tor Skibsted Clemmensen ◽  
Niels Ramsing Holm ◽  
Hans Eiskjær ◽  
Steen Hvitfeldt Poulsen ◽  
Michael Maeng ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Optical Coherence Tomography ◽  
Coronary Artery ◽  
Thrombus Formation ◽  
Coronary Intervention ◽  
Suspected Coronary Artery Disease ◽  
Optical Coherence ◽  
Mural Thrombus ◽  
Clinical Value ◽  
Underlying Mechanisms

The case illustrates the possible link between coronary spasms, intraluminal thrombus formation, and widespread organized and layered thrombi in HTx patients. Furthermore, the case underlines the clinical value of OCT as a novel method for high-resolution vessel imaging in heart-transplanted (HTx) patients with coronary spasms and suspected coronary artery disease. Coronary spasms and sudden death are frequent complications after HTx. The underlying mechanisms leading to these complications are unknown. The present case displays the clinical course of a 19-year-old HTx patient who was hospitalized due to acute myocardial infarction induced by severe coronary spasms. The patients remained unstable on conservative therapy. Therefore, an optical coherence tomography (OCT) was performed and revealed massive, organized thrombi in the left main coronary artery, the circumflex coronary artery, and the left anterior descending coronary artery. The patient was stabilized after percutaneous coronary intervention. As a mural thrombus often goes undetected by coronary angiography, OCT may prove benefit in HTx patients with myocardial infarction or suspected coronary spasms.

scholarly journals Clinical features, management and in-hospital outcome of ST elevation myocardial infarction (STEMI) in young adults under 40 years of age

2016 ◽  
Vol 72 (2) ◽  
Author(s):  
Seyed Kianoosh Hosseini ◽  
Abbas Soleimani ◽  
Abbas Ali Karimi ◽  
Saeed Sadeghian ◽  
Sirous Darabian ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Young Patients ◽  
Coronary Intervention ◽  
Clinical Findings ◽  
Hospital Death ◽  
Old Patients ◽  
St Segment Elevation ◽  
History Of

Objectives: This study was designed to evaluate the demographic and clinical findings and in-hospital management and outcome in patients with an acute ST-segment elevation myocardial infarction (STEMI). Material and methods: By review of the Cardiovascular Tehran Heart Center Registry (CVDTHCR), 2028 patients were found to have the acute STEMI. We compared the patients’ characteristics in 109 (5.4%) subjects ≤40 and 1919 subjects &gt; 40 years old. Results: The young patients had less diabetes, hypertension, dyslipidemia and history of MI or prior revascularization, and were more likely to be male (92.7% vs. 74%), smoker (58.7% vs. 31.7%) and have family history of CVD (50.5% vs. 23.4%). The young patients had higher prevalence of angiographically normal coronary artery (13.7% vs. 0.9%; p&lt;0.001). The young patients were more likely to undergo percutaneous coronary intervention (38.5% vs. 18.6%), whereas coronary artery bypass grafting was more common in the old ones (p&lt;0.001). In-hospital death was markedly different among young and old patients (0.9% and 6.1%, respectively; p&lt;0.01). Conclusion: In STEMI population, the risk profile, clinical findings and severity of coronary disease of the young differ substantially from the elderly counterparts. Young patients with STEMI have a favorable outcome compared with that in older patients.

scholarly journals DEFERRED STENT IMPLANTATION IN PATIENTS WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION AND MASSIVE CORONARY THROMBOSIS

2018 ◽  
Vol 33 (2) ◽  
pp. 16-20 ◽  
Author(s):  
Ya. V. Alekseeva ◽  
E. V. Vyshlov ◽  
V. A. Markov ◽  
S. V. Demyanov
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Stent Implantation ◽  
Coronary Thrombosis ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
No Reflow ◽  
St Segment

By researches it is proved that the phenomenon of no-reflow is an independent predictor of remodeling of the left ventricle at the moment. Particular importance in formation of this phenomenon is the fragmentation of a thrombus with distal embolization of small vessels, which often arise as a complication of the percutaneous coronary intervention during the destruction of a thrombus. Attempts to prevent the development of microvascular obstruction led to the creation of delayed stenting.The Purpose:assessing the efficacy and safety of deferred stent implantation in patients with ST-segment elevation myocardial infarction and massive coronary thrombosis.Material and Methods.12 patients with STEMI are included in a research. In the course of emergency coronary angiography was performed a massive thrombosis of the infarct-related coronary artery was observed with TIMI 2–3 blood flow. The emergency stenting wasn’t carried out to these patients, but continued anti-thrombotic therapy within 24 hours. After one day, repeated the coronary angiography was performed and, according to the indications, performed stenting of residual stenosis.Results.Development of the phenomenon of no-reflow, deaths and coronary events due to reocclusion of the infarctrelated coronary artery at all patients wasn’t observed. Also, all patients had a positive angiographic result in the form of regurgitation of the thrombus as a result of repeated the coronary angiography.Conclusion.Two-stage revascularization with delayed-on-day stenting with massive thrombosis of the infarct-related coronary artery in patients with acute myocardial infarction combined with aggressive antithrombotic therapy may be use in clinical practice to reduce the risk of developing the no-reflow phenomenon.

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