{rfName}
As

Indexed in

License and Use

Icono OpenAccess

Citations

83

Altmetrics

Impact on the Sustainable Development Goals (SDGs)

Analysis of institutional authors

Bellas C.Author

Share

March 19, 2025
Publications
>
Article
Green

Assessment of Neutrophil Extracellular Traps in Coronary Thrombus of a Case Series of Patients with COVID-19 and Myocardial Infarction

Publicated to: JAMA Cardiology. 6 (4): 469-474 - 2021-04-01 6(4), DOI: 10.1001/jamacardio.2020.7308

Authors:

Blasco A; Coronado MJ; Hernández-Terciado F; Martín P; Royuela A; Ramil E; García D; Goicolea J; Del Trigo M; Ortega J; Escudier JM; Silva L; Bellas C
[+]

Affiliations

Hospital Universitario Puerta de Hierro Majadahonda - Author
Hospital Universitario Puerta de Hierro Majadahonda; Centro de Investigación Biomédica en Red de Cáncer - Author
Hospital Universitario Puerta de Hierro Majadahonda; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública - Author
See more

Abstract

Importance: Severe coronavirus disease 2019 (COVID-19) is characterized by the intense formation of neutrophil extracellular traps (NETs), leading to the occlusion of microvessels, as shown in pulmonary samples. The occurrence of ST-elevated myocardial infarction (STEMI) is a serious cardiac manifestation of COVID-19; the intrinsic mechanism of coronary thrombosis appears to still be unknown. Objective: To determine the role of NETs in coronary thrombosis in patients with COVID-19. Design, Setting, and Participants: This was a consecutive series of patients with COVID-19 at an academic tertiary hospital in Madrid, Spain, who underwent primary coronary interventions for STEMI in which coronary aspirates were obtained in the catheterization laboratory using a thrombus aspiration device. Patients with COVID-19 who experienced a STEMI between March 23 and April 11, 2020, from whom coronary thrombus samples were aspirated during primary coronary intervention, were included in the analysis. These patients were compared with a series conducted from July 2015 to December 2015 of patients with STEMI. Main Outcomes and Measures: The presence and quantity of NETs in coronary aspirates from patients with STEMI and COVID-19. The method for the analysis of NETs in paraffin-embedded coronary thrombi was based on the use of confocal microscopy technology and image analysis for the colocalization of myeloperoxidase-DNA complexes and citrullinated histone H3. Immunohistochemical analysis of thrombi was also performed. Clinical and angiographic variables were prospectively collected. Results: Five patients with COVID-19 were included (4 men [80%]; mean [SD] age, 62 [14] years); the comparison group included 50 patients (44 males [88%]; mean [SD] age, 58 [12] years). NETs were detected in the samples of all 5 patients with COVID-19, and the median density of NETs was 61% (95% CI, 43%-91%). In the historical series of patients with STEMI, NETs were found in 34 of 50 thrombi (68%), and the median NET density was 19% (95% CI, 13%-22%; P <.001). All thrombi from patients with COVID-19 were composed of fibrin and polymorphonuclear cells. None of them showed fragments of atherosclerotic plaque or iron deposits indicative of previous episodes of plaque rupture. Conclusions and Relevance: In this small case series of patients with COVID-19 and myocardial infarction, NETs seem to play a major role in the pathogenesis of STEMI in COVID-19 disease. Our findings support the idea that targeting intravascular NETs might be a relevant goal of treatment and a feasible way to prevent coronary thrombosis in patients with severe COVID-19 disease.
[+]

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal JAMA Cardiology due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2021, it was in position 4/143, thus managing to position itself as a Q1 (Primer Cuartil), in the category Cardiac & Cardiovascular Systems. Notably, the journal is positioned above the 90th percentile.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations from Scopus Elsevier, it yields a value for the Field-Weighted Citation Impact from the Scopus agency: 5.83, which indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 13, 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2026-04-04, the following number of citations:

  • Scopus: 77
  • Open Alex: 94
[+]

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2026-04-04:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 91.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 91 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 192.
  • The number of mentions on the social network Facebook: 1 (Altmetric).
  • The number of mentions on the social network X (formerly Twitter): 162 (Altmetric).
  • The number of mentions on Wikipedia: 4 (Altmetric).
  • The number of mentions in news outlets: 11 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.
Continuing with the social impact of the work, it is important to emphasize that, due to its content, it can be assigned to the area of interest of ODS 3 - Ensure healthy lives and promote well-being for all at all ages, with a probability of 46% according to the mBERT algorithm developed by Aurora University.
[+]

Leadership analysis of institutional authors

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: Last Author (BELLAS MENENDEZ, CARMEN).

[+]