Red blood cell and platelet microparticles in myocardial infarction patients treated with primary angioplasty
Introduction
Although coronary artery disease is a pathologic process involving mainly the vascular wall, it has long been known that blood constituents, including coagulation and fibrinolysis factors, inflammatory cells and mediators and, of course, platelets, also play an important role in ischemic heart disease manifestations and their sequelae [1], [2]. Among cellular blood constituents, red blood cells (RBCs) have probably received the least attention in the context of acute coronary syndrome pathophysiology, although it is conceivable that this most abundant blood element could well be implicated in the complex crosstalk of processes taking place in the ischemic area vasculature. Indeed, RBC hemolysis and microparticle formation has been shown – in an experimental setting – to cause decreased nitric oxide bioavailability and vascular dysfunction [3], but their role in a clinical setting of cardiovascular disease has not been investigated.
We used flow cytometry to quantify RBC microparticles (RBCm), RBC transitional cells (RBCt; small-sized, less than 3 μm, but larger than microparticles, erythrocyte cell forms), and platelet microparticles (PLTm) in peripheral blood of ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI), according to current guidelines [4], with a dual goal: compare them to a reference group of healthy controls and assess potential associations with subsequent clinical events.
Section snippets
Study design, population and procedures
This study consisted of two parts, one part being a two-group cross-sectional observational study (comparison of STEMI patients with a reference group), while the second part was a prospective, cohort study (prospective follow-up of STEMI patients for clinical events – see below). Consecutive patients referred for primary PCI were screened for inclusion. Eligible patients had at least 0.1-mV ST-segment elevation in three contiguous leads with associated chest or epigastric pain and consistent
RBC and platelet microparticles in STEMI patients and controls
A total of 101 subjects were enrolled in the study, 51 STEMI patients (age 59.8 ± 8.8 years) and 50 matched controls (age 56.2 ± 9.2 years; p = 0.155), who served as a reference group. RBCm concentration in the reference group was 18,198 ± 6062/μl as compared with 33,740 ± 21,169/μl in STEMI patients (p < 0.001). The frequency distribution of RBCm concentrations in controls was very close to the Gaussian (K-S zeta 0.574; p = 0.896 for the difference from the Gaussian distribution; skewness 0.39 and excess
Discussion
The main findings of the present study are the markedly elevated levels of erythrocyte microparticles in patients with STEMI following primary angioplasty, compared to a reference group of healthy volunteers, and, more importantly, the observed association with post-infarction events. In contrast, PLTm were not found to be significantly different in patients with STEMI in comparison to healthy individuals, and their levels were not associated to outcomes.
Erythrocytes which suffer noxious
Conflicts of interest
All authors have declared that they have no industry relationships or conflicts of interest pertaining to the contents of this manuscript.
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Authors Giannopoulos, Oudatzis and Paterakis contributed equally to this work.