Abstract 249: Cholesterol Crystals Cause Acute Coronary Events by Perforating the Arterial Intima
Background: Plaque rupture and/or erosion is the leading cause of myocardial infarction and strokes. Recently we demonstrated that cholesterol crystallization from liquid to solid forms sharp tipped crystals that expand and tear biological membranes. This study investigated the relationship of cholesterol crystals to plaque rupture and/or erosion leading to thrombosis and acute clinical syndrome (ACS).
Methods: Coronary arteries from twenty patients, 14 males and 6 females (age 20 – 85, mean 48±17 years) who died with ACS (n=10) and other causes (n=10) were evaluated. Light and scanning electron microscopy (SEM) were performed on arterial specimen from autopsy. Tissues were prepared for SEM by dehydration in a vacuum without ethanol processing to avoid dissolving the cholesterol crystals.
Results: All coronary arteries (9/9) with thrombus had crystals tearing through the intima while normal arteries (n=11) and stable plaques (n=6) had none (p<0.0001). All patients with acute coronary syndrome (n=10) had consistent evidence of crystal perforations while those who died of other causes (n=10) did not (p<0.0001). SEM images from patients with ACS demonstrated crystals perforating the intima and plaque surface (a, b) compared to intact normal endothelial surface (c).
Conclusions: Cholesterol crystals perforating the intima of coronary arteries were strongly associated acute coronary syndrome and cardiac death as well as with thrombus at rupture and/or erosion sites. This suggests that cholesterol crystallization is critical to plaque rupture and/or erosion and is associated with thrombosis and clinical events