Abela George S, Kalavakunta Jagadeesh K, Janoudi Abed, Leffler Dale, Dhar Gaurav, Salehi Negar, Cohn Joel, Shah Ibrahim, Karve Milind, Kotaru Veera Pavan K, Gupta Vishal, David Shukri, Narisetty Keerthy K, Rich Michael, Vanderberg Abigail, Pathak Dorothy R, Shamoun Fadi E
Department of Medicine, Michigan State University, East Lansing, Michigan; Division of Cardiology, Michigan State University, East Lansing, Michigan; Division of Pathology, Department of Physiology, Michigan State University, East Lansing, Michigan.
Division of Cardiology, Michigan State University, East Lansing, Michigan; Borgess Hospital, Kalamazoo, Michigan and Michigan State University, East Lansing, Michigan.
Am J Cardiol. 2017 Nov 15;120(10):1699-1707. doi: 10.1016/j.amjcard.2017.07.075. Epub 2017 Aug 31.
Cholesterol crystals (CCs) have been associated with plaque rupture through mechanical injury and inflammation. This study evaluated the presence of CCs during acute myocardial infarction (AMI) and associated myocardial injury, inflammation, and arterial blood flow before and after percutaneous coronary intervention. Patients presenting with AMI (n = 286) had aspiration of culprit coronary artery obstruction. Aspirates were evaluated for crystal content, size, composition, and morphology by scanning electron microscopy, crystallography, and infrared spectroscopy. These were correlated with inflammatory biomarkers, cardiac enzymes, % coronary stenosis, and Thrombolysis in Myocardial Infarction (TIMI) blush and flow grades. Crystals were detected in 254 patients (89%) and confirmed to be cholesterol by spectroscopy. Of 286 patients 240 (84%) had CCs compacted into clusters that were large enough to be measured and analyzed. Moderate to extensive CC content was present in 172 cases (60%). Totally occluded arteries had significantly larger CC clusters than partially occluded arteries (p <0.05). Patients with CC cluster area >12,000 µm had significantly elevated interleukin-1 beta (IL-1β) levels (p <0.01), were less likely to have TIMI blush grade of 3 (p <0.01), and more likely to have TIMI flow grade of 1 (p <0.01). Patients with recurrent AMI had smaller CC cluster area (p <0.04), lower troponin (p <0.02), and IL-1β levels (p <0.04). Women had smaller CC clusters (p <0.04). Macrophages in the aspirates were found to be attached to CCs. Coronary artery aspirates had extensive deposits of CCs during AMI. In conclusion, presence of large CC clusters was associated with increased inflammation (IL-1β), increased arterial narrowing, and diminished reflow following percutaneous coronary intervention.
胆固醇结晶（CCs）已被证实可通过机械损伤和炎症反应导致斑块破裂。本研究旨在评估急性心肌梗死（AMI）期间CCs的存在情况，以及经皮冠状动脉介入治疗前后与之相关的心肌损伤、炎症反应和动脉血流情况。286例AMI患者接受了罪犯冠状动脉阻塞部位的抽吸。通过扫描电子显微镜、晶体学和红外光谱对抽吸物的晶体成分、大小、组成和形态进行评估。将这些结果与炎症生物标志物、心肌酶、冠状动脉狭窄百分比以及心肌梗死溶栓（TIMI）血流灌注分级和血流分级进行关联分析。在254例患者（89%）中检测到晶体，并通过光谱分析确认为胆固醇。286例患者中，240例（84%）的CCs聚集成足够大的团块，可进行测量和分析。172例（60%）存在中度至广泛的CCs成分。完全闭塞的动脉中CCs团块明显大于部分闭塞的动脉（p<0.05）。CCs团块面积>12,000 µm的患者白细胞介素-1β（IL-1β）水平显著升高（p<0.01），TIMI血流灌注分级为3级的可能性较小（p<0.01），而TIMI血流分级为1级的可能性较大（p<0.01）。复发性AMI患者的CCs团块面积较小（p<0.04），肌钙蛋白水平较低（p<0.02），IL-1β水平较低（p<0.04）。女性的CCs团块较小（p<0.04）。抽吸物中的巨噬细胞附着于CCs上。AMI期间冠状动脉抽吸物中有大量CCs沉积。总之，大型CCs团块的存在与炎症反应增加（IL-1β）、动脉狭窄增加以及经皮冠状动脉介入治疗后再灌注减少有关。
