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Thromb Haemost 2022; 122(08): 1415-1428
DOI: 10.1055/a-1709-5271
Atherosclerosis and Ischaemic Disease

Prognostic Implications of Neutrophil Extracellular Traps in Coronary Thrombi of Patients with ST-Elevation Myocardial Infarction

Ana Blasco
1   Cardiology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
,
María-José Coronado
2   Confocal Microscopy Unit, Instituto de Investigación Puerta de Hierro-Segovia de Arana, Madrid, Spain
,
Paula Vela
1   Cardiology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
,
Paloma Martín
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
,
Jorge Solano
1   Cardiology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
,
Elvira Ramil
6   Sequencing and Molecular Biology Unit, Instituto de Investigación Puerta de Hierro-Segovia de Arana, Madrid, Spain
,
Aína Mesquida
2   Confocal Microscopy Unit, Instituto de Investigación Puerta de Hierro-Segovia de Arana, Madrid, Spain
,
Adrián Santos
3   Molecular Pathology Laboratory, Instituto de Investigación Puerta de Hierro-Segovia de Arana, Madrid, Spain
,
Beatriz Cózar
2   Confocal Microscopy Unit, Instituto de Investigación Puerta de Hierro-Segovia de Arana, Madrid, Spain
,
Ana Royuela
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
,
Diego García
4   Pathology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
,
Susana Camarzana
1   Cardiology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
,
Carolina Parra
1   Cardiology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
,
Juan F. Oteo
1   Cardiology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
,
Javier Goicolea
1   Cardiology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
,
Carmen Bellas
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
› Author Affiliations Funding This work was supported by the Sociedad Española de Cardiología through the grant ‘Proyecto de Investigación en Cardiología de la Sociedad Española de Cardiología 2017’. B.C. and A.M. received funding from Boston Scientific, Spain to carry out the project. The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
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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.

Keywords

ST-elevated myocardial infarction - coronary thrombi - neutrophil extracellular traps - atherosclerotic plaque - prognosis

Supplementary Material



Publication History

Received: 22 June 2021

Accepted: 26 November 2021

Accepted Manuscript online:
30 November 2021

Article published online:
20 January 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

Comment to this article:

Neutrophil Extracellular Traps in the Infarct-Related Coronary Artery—A Marker or Mediator of Adverse Outcome?Thromb Haemost 2022; 122(08): 1251-1254
DOI: 10.1055/a-1733-9217

 

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