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J Am Coll Cardiol, 2002; 40:1579-1588
© 2002 by the American College of Cardiology Foundation
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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{dagger}

* Anatomic Pathology Division, University of Rome Tor Vergata, Rome, Italy
{dagger} 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.

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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Copyright © 2002 by the American College of Cardiology Foundation.