Bacterial Signatures in Thrombus Aspirates of Patients With Myocardial Infarction

Abstract

Background-Infectious agents, especially bacteria and their components originating from the oral cavity or respiratory tract, have been suggested to contribute to inflammation in the coronary plaque, leading to rupture and the subsequent development of coronary thrombus. We aimed to measure bacterial DNA in thrombus aspirates of patients with STsegment-elevation myocardial infarction and to check for a possible association between bacteria findings and oral pathology in the same cohort. Methods and Results-Thrombus aspirates and arterial blood from patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention (n=101; 76% male; mean age, 63.3 years) were analyzed with real-time quantitative polymerase chain reaction with specific primers and probes to detect bacterial DNA from several oral species and Chlamydia pneumoniae. The median value for the total amount of bacterial DNA in thrombi was 16 times higher than that found in their blood samples. Bacterial DNA typical for endodontic infection, mainly oral viridans streptococci, was measured in 78.2% of thrombi, and periodontal pathogens were measured in 34.7%. Bacteria-like structures were detected by transmission electron microscopy in all 9 thrombus samples analyzed; whole bacteria were detected in 3 of 9 cases. Monocyte/macrophage markers for bacteria recognition (CD14) and inflammation (CD68) were detected in thrombi (8 of 8) by immunohistochemistry. Among the subgroup of 30 patients with myocardial infarction examined by panoramic tomography, a significant association between the presence of periapical abscesses and oral viridans streptococci DNA-positive thrombi was found (odds ratio, 13.2; 95% confidence interval, 2.11-82.5; P=0.004). Conclusions-Dental

Coronary Neutrophil Extracellular Trap Burden and Deoxyribonuclease Activity in ST-Elevation Acute Coronary Syndrome Are Predictors of ST-Segment Resolution and Infarct Size

“…We chose 8 target species (Streptococcus species, mainly Streptococcus mitis group, Staphylococcus aureus, Staphylococcus epidermidis, Prevotella intermedia, Fusobacterium nucleatum, Aggregatibacter [née Actinobacillus] actinomycetemcomitans, Dialister pneumosintes, Porphyromonas gingivalis, and Parvimonas micra), yielding the highest copy number levels in CLS aspirates of a most recent study, 16 including their oligonucleotide primers and probes. The detection limit was 40 cycles.…”

Immunoglobulin G antibodies againstPorphyromonas gingivalisorAggregatibacter actinomycetemcomitansin cardiovascular disease and periodontitis

“…Another potential pathogenic pathway is spillover of inflammatory mediators from periodontal tissues to the circulation during such everyday oral procedures [40]. Notably, both viable oral bacteria and DNA from oral bacteria have been isolated in atheromatous plaques distant from the oral cavity [44–46]. Concomitant changes in endothelial permeability promote the entry and retention of cholesterol-containing low-density lipoprotein particles in the artery wall, which may aggravate atherosclerotic lesions and thus the risk of cardiovascular events [47].…”

Letter by Ammirati and Maseri Regarding Article, “Bacterial Signatures in Thrombus Aspirates of Patients With Myocardial Infarction”

“…Oral viridans streptococci was measured in 78% of thrombi and periodontal pathogens in 35%. 1 Furthermore, there was a significant association between the presence of periapical abscess and endodontic bacteria in the thrombus aspirates (odds ratio, 7.71) in 30 patients with available dental panoramic tomography. This is an exciting finding that begs the question of how the presence of a chronic oral infection can mediate an acute transition to plaque thrombosis.…”

“…Pessi et al 1 showed in 101 cases of ST-segment elevation myocardial infarction that bacterial DNA typical for endodontic infection was 16 times higher in thrombi than that found in patients' blood samples. Oral viridans streptococci was measured in 78% of thrombi and periodontal pathogens in 35%.…”