Stalikas Nikolaos, Tzorakoleftheraki Sofia-Eleni, Karagiannidis Efstratios, Didagelos Matthaios, Ziakas Antonios, Kamperidis Vasileios, Giannakoulas George, Vassilikos Vasileios, Koletsa Triantafyllia, Giannopoulos George
First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece.
Pathology Department, Medical School, Aristotle University of Thessaloniki, Greece.
Hellenic J Cardiol. 2024 Sep 7. doi: 10.1016/j.hjc.2024.09.001.
The precise triggers for atherosclerotic plaque rupture and the underlying pathophysiology of coronary thrombogenesis remain elusive. Polymorphonuclear neutrophils, particularly their formation of neutrophil extracellular traps (NETs), have garnered attention in the context of coronary atherothrombosis. This study sought to explore the association of NETs burden with clinical and angiographic characteristics in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI) and thrombus aspiration (TA).
For this study, 336 consecutive STEMI patients undergoing pPCI were considered for TA. Aspirated thrombi underwent histological analysis and NETs quantification via immunohistochemistry. Potential associations of clinical variables and angiographic outcomes with NETs burden were assessed.
Manual TA was selectively performed in 72 cases with increased thrombotic burden, and 60 thrombi were suitable for analysis and included in the current study. Most thrombi specimens displayed lytic features (63%), and almost three out of four were identified as white thrombi. Increased NETs burden was significantly associated with prolonged pain-to-balloon time (>300 min), OR = 10.29 (95% CI 2.11-42.22, p = 0.001), and stress-induced hyperglycemia OR = 6.58 (95% CI 1.23-52.63, p < 0.01) after multivariate regression analysis. Additionally, distal embolization, and left ventricular ejection fraction ≤40% were more frequent among patients with an elevated NETs burden OR = 16.9 (95% CI 4.23-44.52, p < 0.01) and OR = 3.2 (95% CI 1.05-12.1, p = 0.05), respectively.
Elevated NETs burden in STEMI thrombi may be due to delayed reperfusion and stress-induced hyperglycemia, and it is associated with an increased risk of distal embolization and lower left ventricular ejection fraction. Further research is needed to elucidate the role of NETs as a potential therapeutic target in acute atherothrombosis.
动脉粥样硬化斑块破裂的确切触发因素以及冠状动脉血栓形成的潜在病理生理学机制仍不清楚。多形核中性粒细胞，尤其是它们形成的中性粒细胞胞外陷阱（NETs），在冠状动脉粥样硬化血栓形成的背景下受到了关注。本研究旨在探讨接受直接经皮冠状动脉介入治疗（pPCI）和血栓抽吸（TA）的ST段抬高型心肌梗死（STEMI）患者中NETs负荷与临床及血管造影特征之间的关联。
在本研究中，336例连续接受pPCI的STEMI患者被考虑进行TA。对抽吸的血栓进行组织学分析，并通过免疫组织化学对NETs进行定量。评估临床变量和血管造影结果与NETs负荷之间的潜在关联。
对72例血栓负荷增加的患者选择性地进行了手动TA，其中60个血栓适合分析并纳入本研究。大多数血栓标本呈现溶解特征（63%），并且四分之三的血栓被鉴定为白色血栓。经过多变量回归分析，NETs负荷增加与疼痛至球囊扩张时间延长（>300分钟）显著相关，OR = 10.29（95%CI 2.11 - 42.22，p = 0.001），以及应激性高血糖相关，OR = 6.58（95%CI 1.23 - 52.63，p < 0.01）。此外，NETs负荷升高的患者中远端栓塞和左心室射血分数≤40%更为常见，OR分别为16.9（95%CI 4.23 - 44.52，p < 0.01）和OR = 3.2（95%CI 1.05 - 12.1，p = 0.05）。
STEMI血栓中NETs负荷升高可能归因于再灌注延迟和应激性高血糖，并且与远端栓塞风险增加和左心室射血分数降低相关。需要进一步研究以阐明NETs作为急性动脉粥样硬化血栓形成潜在治疗靶点的作用。
