Abstract 11906: Coronary Intraplaque Hemorrhage Evoked Anti-inflammatory Macrophage Accelerates Ventricular Functional Recovery in Patients with Myocardial Infarction
Background: Coronary intraplaque hemorrhage (IPH) accelerates atherosclerosis and contributes to lesion development and destabilization. Extracellular hemoglobin is cleared by CD163, a macrophage scavenger receptor. This process provokes the secretion of the anti-inflammatory atheroprotective cytokine interleukin (IL)-10 by macrophage. Therefore, coronary plaque and thrombus related to IPH may contain anti-inflammatory macrophage, and modify the functional recovery of reperfused myocardium after successful PCI.
Methods: In 40 patients with first myocardial infarction, coronary atherothrombotic debris was retrieved during primary PCI using a filter based distal protection device (Filtrap, NIPRO, Japan). The debris was stained with antibodies to CD163, CD14 (a proinflammatory macrophage surface marker), and IL-10. Left ventricular (LV) function was determined by echocardiography before, 20day after, and 6months after PCI. Patients were divided into two groups: CD163>10% (IPH+, n=20) and CD163<10% (IPH-, n=20). Optimal medication was administered in both groups.
Results: Average CD163 positive macrophage (+) was 26.3±13.7% in IPH+, and 3.2±2.9% in IPH-. Compared to IPH-, IPH+ had larger debris, more CD14+ (19.6±9.2% vs 4.4±6.4%, p<0.01) and more IL-10+ (46.2±17.0% vs 17.7±13.4%, p<0.01). IL-10+ had close correlation with CD163+ (r=0.726, p<0.01). Final TIMI flow grade was lower in IPH+ (2.5±0.9 vs 30±0.0, p<0.05). In subgroups with final TIMI-3 flow (IPH+3, n=15; IPH-3, n=20), both the time to reperfusion and peak CK were similar between the two subgroups. LV dimensions and fractional shortening (%FS) before PCI were similar in both subgroups. Compared to IPH-3, recovery of %FS were accelerated in IPH+3 at 20days after PCI (3.2±5.1% vs -1.5±6.0% p<0.04). Significant correlation was observed between %IL10+ and changes in LV dimensions (diastole: r=-0.594, p<0.01; systole: r=-0.679, p<0.01) and %FS (r=0.532, p<0.01) at 6months after PCI.
Conclusions: Coronary intraplaque hemorrhage has relation with large thrombus and impaired distal flow after primary PCI. However, it enhances anti-inflammatory macrophage expression and accelerates ventricular functional recovery after successful reperfusion.
- © 2011 by American Heart Association, Inc.