open access

Vol 80, No 4 (2022)
Original article
Published online: 2022-02-13
Get Citation

The association between whole blood viscosity and high thrombus burden in patients with non-ST elevation myocardial infarction

Tufan Çınar1, Faysal Şaylık2, Tayyar Akbulut2, Suha Asal1, Murat Selçuk1, Vedat Çiçek1, Ahmet Lütfullah Orhan1
DOI: 10.33963/KP.a2022.0043
·
Pubmed: 35152394
·
Kardiol Pol 2022;80(4):429-435.
Affiliations
  1. Department of Cardiology, Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
  2. Department of Cardiology, Van Training and Research Hospital, Van, Turkey

open access

Vol 80, No 4 (2022)
Original article
Published online: 2022-02-13

Abstract

Background: Prior studies showed that patients with elevated whole blood viscosity (WBV) had a higher risk of arterial thrombosis, acute stent thrombosis, and left ventricular apical thrombus presence after acute coronary syndrome. This investigation aimed to determine the association between WBV and high thrombus burden (HTB) in non-ST elevation myocardial infarction (NSTEMI) patients treated with percutaneous coronary intervention (PCI).
Methods: This retrospective cohort investigation included data from consecutive 290 NSTEMI patients who received PCI at a tertiary institution. Patients with grade 1–3 thrombus burden were categorized as having low thrombus burden (LTB) (n = 178), whereas those with grade 4–5 thrombus burden were classified as having HTB (n = 112). WBV at high shear rate (HSR) and low shear rate (LSR) were estimated using hematocrit (HTC) and total protein levels.
Results: Patients with HTB had higher WBV at both LSR and HSR. In HTB patients, the frequency of infarct-related artery (IRA) reference vessel diameter, distal embolization, and no-reflow was also higher. Multivariable logistic regression models indicated that WBV at LSR (odds ratio [OR], 1.028; 95% confidence interval [CI], 1.014–1.043; P < 0.001) and HSR (OR, 1.606; 95% CI, 1.334–1.953; P < 0.001) were independent predictors of HTB in NSTEMI patients. Notably, the area under the curve value of WBV at both shear rates was greater than that of its components, including total protein and HTC.
Conclusion: This is the first study showing that WBV at both shear rates is a significant predictor of HTB in NSTEMI patients.

Abstract

Background: Prior studies showed that patients with elevated whole blood viscosity (WBV) had a higher risk of arterial thrombosis, acute stent thrombosis, and left ventricular apical thrombus presence after acute coronary syndrome. This investigation aimed to determine the association between WBV and high thrombus burden (HTB) in non-ST elevation myocardial infarction (NSTEMI) patients treated with percutaneous coronary intervention (PCI).
Methods: This retrospective cohort investigation included data from consecutive 290 NSTEMI patients who received PCI at a tertiary institution. Patients with grade 1–3 thrombus burden were categorized as having low thrombus burden (LTB) (n = 178), whereas those with grade 4–5 thrombus burden were classified as having HTB (n = 112). WBV at high shear rate (HSR) and low shear rate (LSR) were estimated using hematocrit (HTC) and total protein levels.
Results: Patients with HTB had higher WBV at both LSR and HSR. In HTB patients, the frequency of infarct-related artery (IRA) reference vessel diameter, distal embolization, and no-reflow was also higher. Multivariable logistic regression models indicated that WBV at LSR (odds ratio [OR], 1.028; 95% confidence interval [CI], 1.014–1.043; P < 0.001) and HSR (OR, 1.606; 95% CI, 1.334–1.953; P < 0.001) were independent predictors of HTB in NSTEMI patients. Notably, the area under the curve value of WBV at both shear rates was greater than that of its components, including total protein and HTC.
Conclusion: This is the first study showing that WBV at both shear rates is a significant predictor of HTB in NSTEMI patients.

Get Citation

Keywords

whole blood viscosity, thrombus burden, high, non-ST elevation myocardial infarction

About this article
Title

The association between whole blood viscosity and high thrombus burden in patients with non-ST elevation myocardial infarction

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 80, No 4 (2022)

Article type

Original article

Pages

429-435

Published online

2022-02-13

Page views

360

Article views/downloads

145

DOI

10.33963/KP.a2022.0043

Pubmed

35152394

Bibliographic record

Kardiol Pol 2022;80(4):429-435.

Keywords

whole blood viscosity
thrombus burden
high
non-ST elevation myocardial infarction

Authors

Tufan Çınar
Faysal Şaylık
Tayyar Akbulut
Suha Asal
Murat Selçuk
Vedat Çiçek
Ahmet Lütfullah Orhan

References (27)
  1. Crea F, Libby P. Acute coronary syndromes: the way forward from mechanisms to precision treatment. Circulation. 2017; 136(12): 1155–1166.
  2. Sianos G, Papafaklis MI, Daemen J, et al. Angiographic stent thrombosis after routine use of drug-eluting stents in ST-segment elevation myocardial infarction: the importance of thrombus burden. J Am Coll Cardiol. 2007; 50(7): 573–583.
  3. Goto K, Lansky AJ, Nikolsky E, et al. Prognostic significance of coronary thrombus in patients undergoing percutaneous coronary intervention for acute coronary syndromes: a subanalysis of the ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) trial. JACC Cardiovasc Interv. 2011; 4(7): 769–777.
  4. Cekirdekci EI, Bugan B. Whole blood viscosity in microvascular angina and coronary artery disease: Significance and utility. Rev Port Cardiol (Engl Ed). 2020; 39(1): 17–23.
  5. Hathcock JJ. Flow effects on coagulation and thrombosis. Arterioscler Thromb Vasc Biol. 2006; 26(8): 1729–1737.
  6. Erdoğan G, Yenerçağ M, Arslan U. The relationship between blood viscosity and acute arterial occlusion. J Cardiovasc Emergencies. 2020; 6(1): 7–12.
  7. Ekizler FA, Cay S, Tak BT, et al. Usefulness of the whole blood viscosity to predict stent thrombosis in ST-elevation myocardial infarction. Biomark Med. 2019; 13(15): 1307–1320.
  8. Çırakoğlu ÖF, Aslan AO, Yilmaz AS, et al. Usefulness of whole blood viscosity estimated by de Simeone's formula to predict left ventricular thrombus formation within one year following acute anterior myocardial infarction. Biorheology. 2020; 57(1): 37–51.
  9. Collet JP, Thiele H, Barbato E, et al. ESC Scientific Document Group. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021; 42(14): 1289–1367.
  10. de Simone G, Devereux RB, Chinali M, et al. Association of blood pressure with blood viscosity in american indians: the Strong Heart Study. Hypertension. 2005; 45(4): 625–630.
  11. Gibson CM, de Lemos JA, Murphy SA, et al. Combination therapy with abciximab reduces angiographically evident thrombus in acute myocardial infarction: a TIMI 14 substudy. Circulation. 2001; 103(21): 2550–2554.
  12. Tanboga IH, Topcu S, Aksakal E, et al. Determinants of angiographic thrombus burden in patients with ST-segment elevation myocardial infarction. Clin Appl Thromb Hemost. 2014; 20(7): 716–722.
  13. Chesebro JH, Knatterud G, Roberts R, et al. Thrombolysis in Myocardial Infarction (TIMI) Trial, Phase I: A comparison between intravenous tissue plasminogen activator and intravenous streptokinase. Clinical findings through hospital discharge. Circulation. 1987; 76(1): 142–154.
  14. Henriques JPS, Zijlstra F, van 't Hof AWJ, et al. Angiographic assessment of reperfusion in acute myocardial infarction by myocardial blush grade. Circulation. 2003; 107(16): 2115–2119.
  15. Svilaas T, Vlaar PJ, van der Horst IC, et al. Thrombus aspiration during primary percutaneous coronary intervention. N Engl J Med. 2008; 358(6): 557–567.
  16. Gianstefani S, Douiri A, Delithanasis I, et al. Incidence and predictors of early left ventricular thrombus after ST-elevation myocardial infarction in the contemporary era of primary percutaneous coronary intervention. Am J Cardiol. 2014; 113(7): 1111–1116.
  17. Napodano M, Dariol G, Al Mamary AH, et al. Thrombus burden and myocardial damage during primary percutaneous coronary intervention. Am J Cardiol. 2014; 113(9): 1449–1456.
  18. Fukumoto Y, Hiro T, Fujii T, et al. Localized elevation of shear stress is related to coronary plaque rupture: a 3-dimensional intravascular ultrasound study with in-vivo color mapping of shear stress distribution. J Am Coll Cardiol. 2008; 51(6): 645–650.
  19. Davies PF. Hemodynamic shear stress and the endothelium in cardiovascular pathophysiology. Nat Clin Pract Cardiovasc Med. 2009; 6(1): 16–26.
  20. Nader E, Skinner S, Romana M, et al. Blood Rheology: Key Parameters, Impact on Blood Flow, Role in Sickle Cell Disease and Effects of Exercise. Front Physiol. 2019; 10: 1329.
  21. de Simone G, Devereux RB, Chien S, et al. Relation of blood viscosity to demographic and physiologic variables and to cardiovascular risk factors in apparently normal adults. Circulation. 1990; 81(1): 107–117.
  22. Gori T, Wild PS, Schnabel R, et al. The distribution of whole blood viscosity, its determinants and relationship with arterial blood pressure in the community: cross-sectional analysis from the Gutenberg Health Study. Ther Adv Cardiovasc Dis. 2015; 9(6): 354–365.
  23. Yildirim A, Kucukosmanoglu M, Koyunsever NY, et al. Relationship between blood viscosity and no-reflow phenomenon in ST-segment elevation myocardial infarction performed in primary percutaneous coronary interventions. Biomark Med. 2021; 15(9): 659–667.
  24. Tekin Tak B, Ekizler FA, Cay S, et al. Relationship between apical thrombus formation and blood viscosity in acute anterior myocardial infarction patients. Biomark Med. 2020; 14(3): 201–210.
  25. Aksu E. Is it possible to estimate the mortality risk in acute pulmonary embolism by means of novel predictors? A retrospective study. Turkish Journal of Vascular Surgery. 2021; 30(1): 27–34.
  26. Antonova N, Velcheva I. Hemorheological disturbances and characteristic parameters in patients with cerebrovascular disease. Clin Hemorheol Microcirc. 1999; 21(3-4): 405–408.
  27. Cannon CP. Small molecule glycoprotein IIb/IIIa receptor inhibitors as upstream therapy in acute coronary syndromes: insights from the TACTICS TIMI-18 trial. J Am Coll Cardiol. 2003; 41(4 Suppl S): 43S–48S.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Sp. z o.o. VM Group Sp.k., ul. Świętokrzyska 73 , 80–180 Gdańsk, Poland

phone:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl