Ana Blasco1, María-José Coronado2, Paula Vela1, Paloma Martín3,4,5, Jorge Solano1, Elvira Ramil6, Aína Mesquida2, Adrián Santos3, Beatriz Cózar2, Ana Royuela7,8, Diego García4, Susana Camarzana1, Carolina Parra1, Juan F Oteo1, Javier Goicolea1, Carmen Bellas3,4,5. 1. Cardiology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain. 2. Confocal Microscopy Unit, Instituto de Investigación Puerta de Hierro-Segovia de Arana, Madrid, Spain. 3. Molecular Pathology Laboratory, Instituto de Investigación Puerta de Hierro-Segovia de Arana, Madrid, Spain. 4. Pathology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain. 5. Centro de Investigación Biomédica en Red (CIBERONC), Madrid, Spain. 6. Sequencing and Molecular Biology Unit, Instituto de Investigación Puerta de Hierro-Segovia de Arana, Madrid, Spain. 7. Biostatistics Unit, Instituto de Investigación Puerta de Hierro-Segovia de Arana, Madrid, Spain. 8. Center for Biomedical Research in Epidemiology and Public Health Network (CIBERESP), Madrid, Spain.
Abstract
AIMS: The mechanisms of coronary thrombosis can influence prognosis after ST-elevation myocardial infarction (STEMI) and allow for different treatment groups to be identified; an association between neutrophil extracellular traps (NETs) and unfavorable clinical outcomes has been suggested. Our aim was to determine the role played by NETs in coronary thrombosis and their influence on prognosis. The role of other histological features in prognosis and the association between NETs and bacteria in the coronary thrombi were also explored. METHODS AND RESULTS: We studied 406 patients with STEMI in which coronary thrombi were consecutively obtained by aspiration during angioplasty between 2012 and 2018. Analysis of NETs in paraffin-embedded thrombi was based on the colocalization of specific NET components by means of confocal microscopy. Immunohistochemistry stains were used to identify plaque fragments. Fluorescence in situ hybridization was used to detect bacteria.NETs were detected in 51% of the thrombi (NET density, median [interquartile range]: 25% [17-38%]). The median follow-up was 47 months (95% confidence interval [CI] 43-51); 105 (26%) patients experienced major adverse cardiac events (MACE). A significant association was found between the presence of NETs in coronary aspirates and the occurrence of MACE in the first 30 days after infarction (hazard ratio 2.82; 95% CI 1.26-6.35, p = 0.012), mainly due to cardiac deaths and stent thrombosis. CONCLUSION: The presence of NETs in coronary thrombi was associated with a worse prognosis soon after STEMI. In some patients, NETs could be a treatment target and a feasible way to prevent reinfarction. Thieme. All rights reserved.
AIMS: The mechanisms of coronary thrombosis can influence prognosis after ST-elevation myocardial infarction (STEMI) and allow for different treatment groups to be identified; an association between neutrophil extracellular traps (NETs) and unfavorable clinical outcomes has been suggested. Our aim was to determine the role played by NETs in coronary thrombosis and their influence on prognosis. The role of other histological features in prognosis and the association between NETs and bacteria in the coronary thrombi were also explored. METHODS AND RESULTS: We studied 406 patients with STEMI in which coronary thrombi were consecutively obtained by aspiration during angioplasty between 2012 and 2018. Analysis of NETs in paraffin-embedded thrombi was based on the colocalization of specific NET components by means of confocal microscopy. Immunohistochemistry stains were used to identify plaque fragments. Fluorescence in situ hybridization was used to detect bacteria.NETs were detected in 51% of the thrombi (NET density, median [interquartile range]: 25% [17-38%]). The median follow-up was 47 months (95% confidence interval [CI] 43-51); 105 (26%) patients experienced major adverse cardiac events (MACE). A significant association was found between the presence of NETs in coronary aspirates and the occurrence of MACE in the first 30 days after infarction (hazard ratio 2.82; 95% CI 1.26-6.35, p = 0.012), mainly due to cardiac deaths and stent thrombosis. CONCLUSION: The presence of NETs in coronary thrombi was associated with a worse prognosis soon after STEMI. In some patients, NETs could be a treatment target and a feasible way to prevent reinfarction. Thieme. All rights reserved.