Allergic Inflammation Is Associated With Coronary Instability and a Worse Clinical Outcome After Acute Myocardial Infarction

Giampaolo Niccoli; Camilla Calvieri; Davide Flego; Giancarla Scalone; Asya Imaeva; Vito Sabato; Domenico Schiavino; Giovanna Liuzzo; Filippo Crea

doi:10.1161/CIRCINTERVENTIONS.115.002554

Allergic Inflammation Is Associated With Coronary Instability and a Worse Clinical Outcome After Acute Myocardial Infarction

Circ Cardiovasc Interv. 2015 Aug;8(8):e002554. doi: 10.1161/CIRCINTERVENTIONS.115.002554.

Authors

Giampaolo Niccoli¹, Camilla Calvieri², Davide Flego², Giancarla Scalone², Asya Imaeva², Vito Sabato², Domenico Schiavino², Giovanna Liuzzo², Filippo Crea²

Affiliations

¹ From the Department of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (G.N., G.S., G.L., F.C.); Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy (C.C.); Institute of Allergology, Catholic University of the Sacred Heart, Rome, Italy (D.F., D.S.); Department of Epidemiology of Chronic Non-Communicable Diseases, Federal State Institution National Research Center for Preventive Medicine, Moscow, Russia (A.I.); and Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Belgium (V.S.). gniccoli73@hotmail.it.
² From the Department of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (G.N., G.S., G.L., F.C.); Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy (C.C.); Institute of Allergology, Catholic University of the Sacred Heart, Rome, Italy (D.F., D.S.); Department of Epidemiology of Chronic Non-Communicable Diseases, Federal State Institution National Research Center for Preventive Medicine, Moscow, Russia (A.I.); and Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Belgium (V.S.).

PMID: 26243785
DOI: 10.1161/CIRCINTERVENTIONS.115.002554

Abstract

Background: The role of allergic inflammation in acute coronary syndromes (ACS) has not been clearly defined to date. Aim of this study was to assess eosinophil and basophil activation in ACS and the prognostic role of eosinophil cationic protein in ST-segment-elevation myocardial infarction.

Methods and results: In a cross-sectional study, we prospectively enrolled 51 patients undergoing percutaneous coronary intervention (60.8% patients with ACS and 39.2% with stable angina). Flow cytometry analysis assessed CD66b, CD69, and CD203c median fluorescence intensity expression. In a follow-up study, 181 patients presenting with ST-segment-elevation myocardial infarction, undergoing primary percutaneous coronary intervention, were prospectively enrolled with a follow-up of 24 months. Eosinophil activation (CD66b) was similar in patients with ACS and stable angina (6.61 [4.91-7.72] versus 6.62 [5.27-8.73], P=0.63), whereas eosinophil degranulation (CD69) and basophil activation (CD203c) were higher in ACS patients compared with stable angina patients (1.38 [1.16-1.52] versus 1.17 [1-1.31], P=0.01); 0.97 [0.89-1.11] versus 0.92 [0.87-0.95], P=0.03, respectively). Eosinophil cationic protein serum levels were significantly higher in ST-segment-elevation myocardial infarction patients with major adverse cardiac events as compared with those without (21.1 [10.37-25.65] versus 7.83 [3.37-12.8] μg/L, P=0.01) and in patients with thrombus score >3 compared with those with thrombus score ≤3 (15.0 [9.8-24.7] versus 5.2 [3.5-22.9] μg/L, P=0.006). Eosinophil cationic protein serum levels predicted major adverse cardiac events during follow-up (odds ratio =1.041, 95% confidence interval 1.012-1.071, P=0.005). C-reactive protein serum levels showed a borderline statistical significance (odds ratio =0.904, 95% confidence interval 0.806-1.014, P=0.085).

Conclusions: These findings are the first demonstration of in vivo eosinophil degranulation and basophil activation during ACS and of the prognostic role of eosinophil cationic protein in ST-segment-elevation myocardial infarction.

Keywords: acute coronary syndrome; allergic cells; inflammation.

MeSH terms

Acute Coronary Syndrome / immunology
Aged
Aged, 80 and over
Angina, Stable / immunology
Basophils / immunology*
C-Reactive Protein / metabolism
Coronary Angiography
Cross-Sectional Studies
Echocardiography
Eosinophil Cationic Protein / blood
Eosinophils / immunology*
Female
Flow Cytometry
Humans
Inflammation / blood*
Male
Middle Aged
Myocardial Infarction / blood*
Myocardial Infarction / diagnosis
Prognosis
Prospective Studies

Substances

C-Reactive Protein
Eosinophil Cationic Protein