Coronary thrombosis is defined as the formation of a blood clot inside a blood vessel of the heart. This blood clot may then restrict
blood flow within the heart, leading to heart tissue damage, or a
myocardial infarction, also known as a heart attack.[1]
A coronary thrombus is
asymptomatic until it causes significant obstruction, leading to various forms of
angina or eventually a
myocardial infarction. Common warning symptoms are crushing chest pain, shortness of breath, and upper body discomfort.[2]
Coronary thrombosis and
myocardial infarction are sometimes used as synonyms, although this is technically inaccurate as the thrombosis refers to the
blocking of blood vessels with a thrombus, while myocardial infarction refers to heart
tissue death due to the consequent loss of
blood flow to the heart. Due to extensive
collateral circulation, a coronary thrombus does not necessarily cause tissue death and may be asymptomatic.[citation needed]
The formation of coronary thrombosis generally follows the same mechanism as other blood clots in the body, the
coagulation cascade. Also applicable is the
Virchow's triad of blood stasis,
endothelial injury, and
hypercoagulable state.
Atherosclerosis contributes to coronary thrombosis formation by facilitating blood stasis as well as causing local endothelial injury.[citation needed]
Due to the large number of cases of myocardial infarction leading to death and disease in the world, there has been extensive study towards the generation of clots specifically in the
coronary arteries.[citation needed] Some areas of focus:
Coronary thrombosis can be a complication associated with
drug-eluting stents.[3] These stents that are placed to open up narrowed arteries are often infused with medicine to prevent repeat stenosis. However, they may actually lead to an increased coronary thrombus formation due to increased
tissue factor expression and delayed healing within the vessels. Furthermore, the downstream
endothelium has been shown to be impaired, leading to an environment that favors formation of clots. Evidence remains inconclusive about whether these risks outweigh the benefit of a coronary arterial stent.[3][4]
Inflammation may play a causal role in coronary artery disease and subsequent myocardial infarction due to coronary thrombosis. Increased levels of inflammation may lead to higher risk of clotting as well as an increased risk of stent/device subsequent thrombosis. There is an ongoing search for inflammatory
biomarkers that can help determine at-risk individuals.[5]
Coronary "microembolization" is being explored as a focal point for coronary thrombus formation and subsequent sudden death due to acute myocardial infarction.[6]
High mobility group box-1 (HMGB-1)
proteins as important mediators in thrombus formation.[7]
Coronary sinus thrombosis as a severe complication after procedures.[8] The coronary sinus is the venous counterpart to the coronary arteries, where de-oxygenated blood returns from heart tissue. A large thrombus here slows overall blood circulation to heart tissue as well as may mechanically compress a coronary artery.[8]
Diagnosis
Clinical signs of myocardial infarction (heart attack) or
angina if coronary thrombus is symptomatic:
platelet P2Y12 receptor inhibitors: a study published in 2001 determined that the addition of
clopidogrel showed a positive effect on cardiovascular mortality, non-fatal heart attack, and stroke at the cost of an increased risk of major bleeding.[citation needed]
To address the possibility of identifying and treating asymptomatic coronary artery disease to prevent development of coronary thrombosis, a study published 2018 determined that preemptive treatment with
percutaneous coronary intervention did not lead to a difference in death or myocardial infarction over a 15-year period.[13]
There are numerous treatments currently being studied for management and prevention of coronary thrombosis.
Statin drugs, in addition to their primary
cholesterol-lowering mechanisms of action, have been studied to target a number of pathways that may decrease coronary
inflammation and subsequent thrombosis.[14]
Another realm of potential treatments in early stages of adoption is in therapeutic use of contrast
ultrasound on thrombus dissolution.[15]
A thrombus is a type of
embolism, a more general term for any material that partially or fully blocks a blood vessel. An
atheroembolism, or cholesterol embolism, is when an
atherosclerotic plaque ruptures and becomes an embolism.
Atherosclerosis is the progressive thickening of blood vessels and plaque formation that eventually can lead to
coronary artery disease.[citation needed]
^Lablanche, J. M.; Perrard, G.; Chmait, A.; Meurice, T.; Sudre, A.; Van Belle, E. (November 2002). "[Coronary thrombosis imaging in humans]". Archives des Maladies du Coeur et des Vaisseaux. 95 Spec No 7: 15–20.
ISSN0003-9683.
PMID12500600.