Intracoronary microparticles and microvascular obstruction in patients with ST elevation myocardial infarction undergoing primary percutaneous intervention
Intracoronary microparticles and microvascular obstruction in patients with ST elevation myocardial infarction undergoing primary percutaneous intervention
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DOI：
10.1093/eurheartj/ehs065
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发表时间：
2012-12-01
影响因子：
39.3
通讯作者：
Crea, Filippo
中科院分区：
文献类型：
--
作者：
Porto, Italo;Biasucci, Luigi Marzio;Crea, Filippo
目的微颗粒（MP）是已知在急性冠状动脉综合征患者血液中增加的细胞来源碎片。我们旨在评估ST段抬高型心肌梗死（STEMI）患者全身和局部（罪魁祸首冠状动脉）血小板源性MP （PMP, CD42CD31）和内皮源性MP （EMP, CD42CD31）水平及其与微血管阻塞（MVO）指标的关系。方法和结果78例经皮冠状动脉介入治疗成功的STEMI患者依次从主动脉和罪魁祸首冠状动脉采血，进行细胞荧光法MP检测。计算心肌梗死溶栓（TIMI）血流、血栓评分（TS）、校正后的TIMI框架计数（cTFC）、心肌红肿分级（MBG）、定量红肿评估器（QuBE）评分和90分钟ST分辨率（SigmaSTR）。冠状动脉内血液样本的PMP和EMP水平均明显高于主动脉样本。冠状动脉内PMP和EMP水平与TS和cTFC呈正相关，与MBG和QuBE呈负相关。主动脉PMP（而非EMP）水平与TS和cTFC相关，与QuBE相反。在一个多变量模型中，冠状动脉内PMP与血管造影和心电图MVO独立相关。结论冠状动脉内EMP、全身和冠状动脉内PMP水平与TS的相关性支持MP作为持续血栓形成标志物的作用。此外，冠状动脉内MP与微血管功能障碍指标的相关性首次表明，MP可能在MVO的发病机制中起直接作用。
Aims Microparticles (MP) are cell-derived fragments known to be increased in the blood of patients with acute coronary syndromes. We aimed to assess, in ST elevation myocardial infarction (STEMI), the systemic and local (in the culprit coronary artery) levels of platelet-derived MP (PMP, CD42CD31) and endothelial-derived MP (EMP, CD42CD31) and their relation to indexes of microvascular obstruction (MVO).Methods and results In 78 STEMI patients undergoing successful primary percutaneous coronary intervention, blood samples were sequentially drawn from the aorta and the culprit coronary artery for cytofluorimetric MP detection. Thrombolysis in myocardial infarction (TIMI) flow, thrombus score (TS), corrected TIMI frame count (cTFC), myocardial blush grade (MBG), quantitative blush evaluator (QuBE) score, and 90 min ST resolution (SigmaSTR) were calculated. Both PMP and EMP levels were significantly higher in the intracoronary than in the aortic blood samples. Intracoronary PMP and EMP levels were positively related to TS and cTFC and inversely related to MBG and QuBE. Aortic PMP (but not EMP) levels were related to TS and cTFC and, inversely, to QuBE. Intracoronary PMP were independently related to angiographic and electrocardiographic MVO in a multivariate model.Conclusion The correlations of intracoronary EMP and of both systemic and intracoronary PMP levels with TS support the role of MP as markers of ongoing thrombosis. Moreover, the correlation of intracoronary MP with indexes of microvascular dysfunction suggests, for the first time, a possible direct role of MP in the pathogenesis of MVO.