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Circulation, Vol 89, 36-44, Copyright © 1994 by American Heart Association
AC van der Wal, AE Becker, CM van der Loos and PK Das
BACKGROUND: The study was designed to verify the concept of plaques "at
risk" and whether inflammation could play a role in plaque rupture and
thrombosis. METHODS AND RESULTS: In 20 patients who had died of acute
myocardial infarction, the thrombosed coronary artery was identified and
the site of plaque rupture was traced in serial sections. The cellular
characteristics of the fibrous cap at the immediate site of rupture were
analyzed and compared with the adjacent cap tissue by use of monoclonal
antibodies reactive with macrophages, T lymphocytes, and smooth muscle
cells. A deep intimal rupture, extending into the lipid core, was
encountered in 12 plaques, whereas 8 had superficial erosions only. Ten
atherosclerotic plaques had a distinctly attenuated fibrous cap covering a
large atheroma, 7 showed a thick fibrocellular cap overlying a lipid pool,
and 3 showed a fibrocellular lesion without a clear lipid core.
Macrophages, and to a lesser extent T lymphocytes, were the dominant cells
at the immediate site of either rupture or superficial erosion in each
instance. These sites, moreover, were always characterized by abundant
expression of HLA-DR antigens on both inflammatory cells and adjacent
smooth muscle cells, suggesting an active inflammatory reaction. In terms
of overall cellular composition of the ruptured plaques, the dominant cell
types were macrophages and T cells in 11, smooth muscle cells in 3, and
mixtures of both in 6. CONCLUSIONS: The underlying atherosclerotic plaque
morphology in complicated coronary artery lesions causing acute myocardial
infarction is heterogeneous with respect to both plaque architecture and
cellular composition. However, the immediate site of plaque rupture or
erosion is always marked by an inflammatory process. This suggests that
inflammation plays a role in destabilizing the fibrous cap tissue and,
thus, in enhancing the risk of coronary thrombosis.
ARTICLES
Site of intimal rupture or erosion of thrombosed coronary atherosclerotic plaques is characterized by an inflammatory process irrespective of the dominant plaque morphology
Department of Cardiovascular Pathology, University of Amsterdam, The Netherlands.
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