Why the study?
Are there significant differences in intracoronary cytokine expression between intact fibrous cap (erosion) and ruptured fibrous cap in patients with STEMI?
Observational (n=40)
No
Are there significant differences in intracoronary cytokine expression between intact fibrous cap (erosion) and ruptured fibrous cap in patients with STEMI?
Plaque erosion (IFC) and plaque rupture (RFC) in STEMI are associated with distinct intracoronary inflammatory profiles, with elevated epidermal growth factor and thrombospondin 1 potentially playing an etiological role in erosion.
Suggests distinct inflammatory pathways drive plaque erosion versus rupture in STEMI; leaves open whether targeting these.
Background Plaque erosion causes 30% of ST‐segment elevation myocardial infarctions, but the underlying cause is unknown. Inflammatory infiltrates are less abundant in erosion compared with rupture in autopsy studies. We hypothesized that erosion and rupture are associated with significant differences in intracoronary cytokines in vivo. Methods and Results Forty ST‐segment elevation myocardial infarction patients with <6 hours of chest pain were classified as ruptured fibrous cap ( RFC ) or intact fibrous cap ( IFC ) using optical coherence tomography. Plasma samples from the infarct‐related artery and a peripheral artery were analyzed for expression of 102 cytokines using arrays; results were confirmed with ELISA . Thrombectomy samples were analyzed for differential mRNA expression using quantitative real‐time polymerase chain reaction. Twenty‐three lesions were classified as RFC (58%), 15 as IFC (38%), and 2 were undefined (4%). In addition, 12% (12 of 102) of cytokines were differentially expressed in both coronary and peripheral plasma. I‐TAC was preferentially expressed in RFC (significance analysis of microarrays adjusted P <0.001; ELISA IFC 10.2 versus RFC 10.8 log 2 pg/mL; P =0.042). IFC was associated with preferential expression of epidermal growth factor ( significance analysis of microarrays adjusted P <0.001; ELISA IFC 7.42 versus RFC 6.63 log 2 pg/mL, P =0.036) and thrombospondin 1 ( significance analysis of microarrays adjusted P =0.03; ELISA IFC 10.4 versus RFC 8.65 log 2 ng/mL, P =0.0041). Thrombectomy mRNA showed elevated I‐TAC in RFC ( P =0.0007) epidermal growth factor expression in IFC ( P =0.0264) but no differences in expression of thrombospondin 1. Conclusions These results demonstrate differential intracoronary cytokine expression in RFC and IFC . Elevated thrombospondin 1 and epidermal growth factor may play an etiological role in erosion.
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Chandran et al. (2017) conducted an observational in ST-segment elevation myocardial infarction (n=40). Ruptured fibrous cap (RFC) vs. Intact fibrous cap (IFC) was evaluated on Differential intracoronary cytokine expression.
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