Heart 1998;80:14-18 ( July )

Recent activation of the plaque immune response in coronary lesions underlying acute coronary syndromes

A C van der Wal,^a J J Piek,^b O J de Boer,^a K T Koch,^b P Teeling,^a C M van der Loos,^a A E Becker^a

^a Department of Cardiovascular Pathology, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, Netherlands, ^b Department of Cardiology, Academic Medical Center, University of Amsterdam

Correspondence to: Dr van der Wal.

Accepted for publication 30 October 1997

ObjectiveTo discriminate between chronic inflammation and acute activation of the plaque immune response in culprit lesions of patients with acute coronary syndromes.
DesignRetrospective study.
SettingTertiary referral centre.
Subjects71 patients having coronary atherectomy were classified according to their ischaemic syndrome: stable angina (n = 23); stabilised unstable angina (n = 18); refractory unstable angina (n = 11); and acute myocardial infarction (n = 19).
Main outcome measuresImmunohistochemical measurement of interleukin 2 receptor (IL-2R) (CD25) positive cells expressed as a percentage of the total amount of (CD3 positive) T lymphocytes in frozen sections of atherectomy specimens.
ResultsThe number of lesions containing IL-2R (CD25) positive T cells increased with severity of the ischaemic coronary syndrome (stable angina, 52%; stabilised unstable angina, 77.8%; refractory unstable angina, 90.9%; acute myocardial infarction, 89.4%). The percentage of activated T cells (CD25/CD3 ratios ×100) increased in lesions associated with refractory unstable angina (7.8%) and acute myocardial infarction (18.5%), compared with those in lesions associated with either chronic stable angina (2.2%) or stabilised unstable angina (3.3%).
ConclusionsAn increase in the percentage of IL-2R positive T lymphocytes in culprit lesions of patients with acute coronary syndromes indicates recent activation and amplification of the immune response within plaques. This may result in a burst of inflammatory products with tissue degrading and vasoactive properties and, hence, could initiate or accelerate the onset of an acute coronary event.

Keywords: interleukins;  T lymphocytes;  acute coronary syndromes;  atherosclerosis

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© 1998 by Heart
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