Bacterial Signatures in Thrombus Aspirates of Patients with Myocardial Infarction
Background—Infectious agents, especially bacteria and their components originating from the oral cavity or respiratory tract have been suggested to contribute to inflammation in the coronary plaque, leading to rupture and the subsequent development of coronary thrombus. We aimed to measure bacterial DNA in thrombus aspirates of patients with ST-elevation myocardial infarction (MI) and to check for possible association between bacteria findings and oral pathology in the same cohort.
Methods and Results—Thrombus aspirates and arterial blood from patients with ST-elevation MI undergoing primary percutaneous coronary intervention (n=101, males 76%, mean age 63.3 years) were analyzed with real-time quantitative PCR with specific primers and probes to detect bacterial DNA from several oral species and Chlamydia pneumoniae. Median value for total amount of bacterial DNA in thrombi was 16 -times higher than that found in their blood samples. Bacterial DNA typical for endodontic infection, mainly oral viridans streptococci, was measured in 78.2% of thrombi and periodontal pathogens in 34.7%. Bacteria-like structures were detected by transmission electron microscopy in all 9/9 thrombi samples analyzed and whole bacteria in 3/9 cases. Monocyte/macrophage markers for bacteria recognition (CD14) and inflammation (CD68) were detected in thrombi (8/8) by immunohistochemistry. Among the subgroup of 30 MI patients examined by panoramic tomography, a significant association between the presence of periapical abscesses and oral viridans streptococci DNA positive thrombi was found (OR 13.2, 95% CI 2.11 - 82.5; p=0.004).
Conclusions—Dental infection and oral bacteria, especially viridans streptococci may be associated with the development of acute coronary thrombosis.
- Received January 10, 2013.
- Accepted January 28, 2013.
- Copyright © 2013, Circulation