Association between coronary thrombus composition and microvascular obstruction following percutaneous coronary intervention in patients with acute myocardial infarction: A proof-of-concept study

Abstract

Coronary microvascular obstruction (CMVO) significantly increases the incidence of major adverse cardiovascular events in patients with acute myocardial infarction (AMI). However, no studies to date have specifically examined the relationship between intracoronary thrombus composition and CMVO formation in AMI patients. This proof-of-concept study aims to investigate the association between coronary thrombus composition and CMVO during AMI. This study enrolled fifty-one patients diagnosed with acute ST-segment elevation myocardial infarction (STEMI) who underwent emergency percutaneous coronary intervention. Intracoronary thrombus specimens were systematically collected during the procedure. Based on established diagnostic criteria for CMVO, participants were stratified into 2 cohorts: the CMVO group exhibiting CMVO (n = 32) and the non-CMVO group without CMVO (n = 19). Histochemical profiling of coronary thrombi was performed to quantify inflammatory and vascular biomarkers including soluble CD40 ligand (sCD40-L), high-sensitivity C-reactive protein (hs-CRP), vascular cell adhesion molecule-1 (VCAM-1), endothelial cell-specific molecule-1 (Endocan), peptidoglycan recognition protein 1 (PGLYRP1), tumor necrosis factor receptor 1 (TNFR1), growth differentiation factor 15 (GDF15), TNF receptor superfamily member 10C (TNFRSF10C), and galectin-3.For quantitative assessment, 2 to 5 random microscopic fields were selected in both the peripheral and core regions of each thrombus specimen. The percentage of positively stained areas was calculated using digital image analysis software (ImageJ, NIH), with mean values derived from all examined fields for intergroup comparisons. Statistical analyses were conducted using SPSS 26.0 with significance threshold set at P < .05. Histochemical quantification showed differential expression of inflammatory mediators in percentage of positively stained areas: sCD40-L, hs-CRP, and VCAM-1 were markedly elevated in thrombi from CMVO patients. Multivariate logistic regression incorporating significant univariate predictors demonstrated, Biomarker analysis revealed significant positive correlations: sCD40-L: B = 0.540, P = .001; hs-CRP: B = 0.264, P = .007; VCAM-1: B = 0.281, P = .013. In addition,the CMVO group (CMVO-positive) demonstrated elevated mean levels of door-to-wire time, Low-Density Lipoprotein Cholesterol (LDL-C), body mass index, and serum interleukin-6 (IL-6) compared to controls. Quantitative analysis of coronary thrombus components revealed significant positive correlations between sCD40-L, hs-CRP, VCAM-1 levels and CMVO prevalence. Moreover, systemic metabolic disturbances - particularly type 2 diabetes mellitus, elevated serum LDL-C concentrations and heightened IL-6 levels were identified as independent predisposing factors for CMVO development.