High Levels of Systemic Myeloperoxidase Are Associated With Coronary Plaque Erosion in Patients With Acute Coronary Syndromes

Abstract

Background-Systemic levels of myeloperoxidase predict prognosis in patients with acute coronary syndromes and are considered a marker of plaque vulnerability. It is not known whether myeloperoxidase is associated with different coronary morphologies (ie, rupture or erosion of the culprit lesion) in patients with acute coronary syndrome. Methods and Results-Twenty-five consecutive patients (aged 67Ϯ11 years; 15 men [60%]; 13 [52%] with non-STsegment elevation acute coronary syndrome and 12 [48%] with acute ST-segment elevation myocardial infarction) were enrolled. Optical coherence tomography classified the culprit lesion as ruptured in 18 (72%) or eroded in 7 patients (28%) and detected intraluminal thrombus in 89% of ruptured plaques and 100% of eroded plaques. Baseline systemic levels of serum myeloperoxidase were significantly higher in patients with an eroded plaque than in those with a ruptured plaque (median, 2500 ng/mL; 25th to 75th percentile, 1415 to 2920 versus median, 707 ng/mL; 25th to 75th percentile, 312 to 943; Pϭ0.001), whereas C-reactive protein levels did not differ significantly (median, 11.3 mg/L; 25th to 75th percentile, 1.3 to 28.5 versus median, 3.9 mg/L; 25th to 75th percentile, 1.3 to 17.8; Pϭ0.76, respectively). In addition, the density of myeloperoxidase-positive cells within thrombi overlying plaques in postmortem coronary specimens retrieved from sudden coronary death victims was significantly higher in lesions with erosion (nϭ11) than ruptures (nϭ11) (median, 1584; 25th to 75th percentile, 1088 to 2135 cells/mm 2 versus median, 579; 25th to 75th percentile, 442 to 760 cells/mm

Early and Transient Release of Leukocyte Pentraxin 3 during Acute Myocardial Infarction

“…To the best of our knowledge, this is the first demonstration of such an event taking place in human patients. Activation of neutrophils across the coronary vascular bed is a hallmark of acute coronary syndromes (30,31,37). Activated neutrophils release the content of their primary granules in the blood: MPO circulating levels in particular are associated with and may predict clinical outcomes in patients with AMI (30,31,37,46).…”

“…Platelets tightly interact with neutrophils and contribute to their activation and recruitment in inflamed tissues via multiple signals: P-selectin, together with b 2 and b 3 integrins, plays a key role (51,52). In turn, the activation of neutrophils, which is effective at fighting invading microbes, is deleterious in conditions of sterile vascular injuries, such as the thrombosis of coronary atherosclerotic plaques (37). The release of the PTX3 prestored in neutrophil granules during AMI may contribute to interrupt this loop, via modulation of events down- stream of P-selectin recognition, including b 2 integrin upregulation and heteroaggregate formation.…”

“…Neutrophils are also known to undergo activation across the coronary vascular bed in patients with acute coronary syndromes, an event that is associated with the release of other biologically active molecules contained into primary granules, such as myeloperoxidase (MPO) (30,31). In this study we examined whether in patients with AMI neutrophils release PTX3, and whether PTX3 modulates the activatory cross-talk between activated platelets and leukocytes, which contributes to coronary thrombosis (32)(33)(34)(35)(36)(37).…”

Thrombus Aspiration Therapy and Coronary Thrombus Components in Patients with Acute ST-Elevation Myocardial Infarction

“…That study demonstrated that the fibrin content increased in association with the ischemic time, ranging from 48.4± 21% (＜3 hours) up to 66.9±9% (＞6 hours) (p = 0.02), whereas the platelet content decreased from 83) . That study consisted of two substudies including 25 ACS patients and 22 sudden coronary death victims.…”

Biomarkers and Coronary Atherosclerotic Burden and Activity as Assessed by Coronary Angiography and Intra-Coronary Imaging Modalities

“…Of interest, the change in fibrous cap thickness had a significant positive correlation with changes in CRP levels (r=0.44, p<0.01). A recently published study by Ferrante et al (Ferrante et al, 2010) enrolled 25 consecutive ACS patients undergoing percutaneous coronary intervention and OCT assessment, evaluating the relationship between plaque morphology and serum levels of myeloperoxidase (MPO) and CRP. OCT classified the culprit lesion as ruptured in 18 (72%) or eroded in 7 patients (28%) and detected intraluminal thrombus in 89% of ruptured plaques and 100% of eroded plaques.…”