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Background: ST Elevation myocardial infarction (STEMI) is characterized by plaque disruption with superimposed thrombus formation. However, studies from western population have suggested a delay between plaque disruption and the onset of symptoms. There is a paucity of Indian data on the relationship between ischemic time and the age of thrombus. Hence, we decided to study the histopathological characteristics of thrombus aspirated during primary percutaneous coronary intervention (PPCI) in patients of STEMI and its relation with the ischemic time. Methods: 107 consecutive patients of STEMI undergoing PPCI with thrombus aspiration, mostly within 12 hours of symptom onset were included in this study. The aspirated thrombi were fixed in 10% formalin, processed and analysed by light microscopy. The thrombi were categorized as recent or lysed according to the histopathological characteristics. Results: The mean age of the study population was 54.93 13.19 years. There were males 94 (87.85%) and 13(12.15%) were females. The culprit vessel was LAD in 36 (32.73%), RCA in 57 (51.82%) and LCX in 13 (11.82%). Left Main, Diagonal and OM were culprit vessels in one case (0.91%) each. Thrombus was identified in 102 (95.3%) out of 107 patients where as in five patients (4.7%) only plaque was seen. Histopathology revealed lysed thrombus in 68 (66.7%) of 102 patients, and recent thrombus in 34 (33.3%) patients. Conclusions: In patients with STEMI, undergoing PPCI within 12 hours of symptom onset, majority of the thrombi were lysed indicative of a thrombus age of at least 24 hours. This suggests that plaque instability and thrombus formation frequently precedes the onset of symptoms. Hence, ischemic time cannot predict the age of thrombus in STEMI.

Background: STEMI is among the most complex and dramatic clinical presentation of coronary artery disease. The highest risk of mortality and stent thrombosis is observed in the subjects undergoing primary PCI. Choice of stent is often critical in Primary Angioplasty in Myocardial Infarction. GenXsync (MIV Therapeutics India Ltd, Surat India) is a stent having hybrid stent platform biodegradable polymers with the confidence of Sirolimus. The primary objective of this study was to establish safety and efficacy of GenXsync Sirolimus Eluting hybrid design stent in STEMI. Methods: A total of 73 patients of STEMI undergoing PCI were enrolled from June 2013 to January 2014. The average door to balloon time was 30±0.04 minutes with the minimumbeing15 minutes and maximum of 2 hours 44min. Most of the patients (69/ 73: 94.52%) underwent primary PCI. One patient (1.37%) was taken up for PCI after successful thrombolysis and two patients had to undergo rescue PCI after failed thrombolysis. All subjects underwent PCI with GenXsync Sirolimus Eluting hybrid design stent. Total 79 stents were used (average 1.08±0.38 stent per patient). The subjects were followed up for one year after discharge. Results: There were 80.82% (59) males, 41.09% (30) diabetic, 27.39% (20) hypertensive, 52.05% (38) current smokers and 2 (2.74%), patients with chronic renal disease. The cardiac history was significantly complex, characterized by prior coronary artery disease in 4 (5.48%), prior MI in 5 (6.85%) including prior PCI in 2 (2.74%), congestive heart failure in 1 (1.37%), ST depression in 71 (97.26%), complete heart block in 4 (5.48%) and left bundle branchblock 1 (1.37%). At admission, 4 (5.4%) patients had cardiac arrest. Among the patients 32 (43.84%), 34 (46.58%), 7 (9.59%) had single, double and triple vessel disease respectively. Average Troponin I was 55.20± 59.34 and by Killip classification, the subjects with class I, class III and class IV were 65 (89.04%), 4 (5.48%), 4 (5.48%) respectively. At discharge there were 3 (3.34%) Major adverse cardiac events and at 1 year, there were 5 (5.48%) major adverse cardiac events. There were no acute stent thromboses. All subjects received dual antiplatelet therapy for one year (Aspirin and one among Clopidogrel, Prasugrel or Ticagrelor at the discretion of the operator). There were total of 2 (2.74%) stent thrombosis events between discharge and 1 year, including in 1 subject who discontinued Antiplatelet therapy within 1 year. None of 4 deaths including 2 cardiac were practically related with the device and procedure. These 4 deaths were due to cardiogenic shock (1), during MVR surgery (1), During surgery on leg, due to major bleeding (1) and Due to pre-existing CHF (1). Conclusions: In contemporary practice of percutaneous coronary intervention in ST Elevation Myocardial Infarction, Genxsync stent was associated with low risks of stent thrombosis and MACE.