CLINICAL STUDY: ACUTE MYOCARDIAL INFARCTION
Multicentric inflammation in epicardial coronary arteries of patients dying of acute myocardial infarction
Luigi Giusto Spagnoli, MD*,*,
Elena Bonanno, MD*,
Alessandro Mauriello, MD*,
Giampiero Palmieri, MD*,
Antonietta Partenzi, MD*,
Giuseppe Sangiorgi, MD* and
Filippo Crea, MD
* Anatomic Pathology Division, University of Rome Tor Vergata, Rome, Italy
Division of Cardiology, Catholic University, Rome, Italy
Manuscript received January 23, 2002;
revised manuscript received July 5, 2002,
accepted July 17, 2002.
* Reprint requests and correspondence: Prof. Luigi Giusto Spagnoli, Anatomia Patologica, Dipartimento di Biopatologia e Diagnostica per Immagini, University of Rome "Tor Vergata," Via della Ricerca Scientifica, 00133 Roma, Italy.
Spagnoli{at}uniroma2.it
OBJECTIVES: We sought to test the hypothesis of whether inflammatory cell infiltration in patients dying of an acute myocardial infarction (MI) is a multifocal event involving multiple coronary branches.
BACKGROUND: Coronary instability is thought to reflect local disruption of a single vulnerable plaque. However, previous postmortem studies have not addressed the question of whether activation of inflammatory cells, particularly T lymphocytes, is limited to the culprit lesion only or rather diffuse in the coronary circulation.
METHODS: We performed a systematic flow cytometric study in three groups of autopsied patients (group 1 = acute MI; group 2 = old MI; group 3 = no ischemic heart disease). Cell suspensions of enzymatically digested coronary arteries were stained for flow cytometry with CD3, CD68, alpha-smooth muscle actin, and human leukocyte antigen (HLA)-DR antibodies.
RESULTS: The coronary plaques showed: 1) a higher proportion of inflammatory cells in groups 1 and 2 than in group 3; 2) a higher percentage of T lymphocytes in group 1 than in group 2 (11.67 ± 0.70% vs. 5.67 ± 0.74%, p = 0.001) and in group 2 than in group 3 (p = 0.008); and 3) diffuse cell activation in the whole coronary tree of group 1, but not of group 2 subjects.
CONCLUSIONS: Our study suggests that lymphocytes may play a key role in coronary instability by determining activation of various cellular types throughout the coronary circulation. Activated T lymphocytes and their products may well represent a new target in both the treatment and prevention of acute coronary syndromes.
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Abbreviations and Acronyms
| | ANOVA | | analysis of variance | | CI | | confidence interval | | FITC | | fluorescein isothiocyanate | | HLA | | human leukocyte antigen | | IRA | | infarct-related artery | | MI | | myocardial infarction | | PBS | | phosphate-buffered saline | | PE | | phycoerythrin | | SMA | | smooth muscle actin | | TTC | | triphenyltetrazolium chloride |
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