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Sudden coronary death, fatal acute myocardial infarction and widespread coronary and myocardial inflammation
  1. Antonio Abbate (abbatea{at}yahoo.com)
  1. VCU, United States
    1. Rossana Bussani
    1. University of Trieste, Italy
      1. Giovanna Liuzzo
      1. Catholic University, Italy
        1. Giuseppe Biondi-Zoccai
        1. University of Torino, Italy
          1. Elena Barresi
          1. University of Trieste, Italy
            1. Pasquale Mellone
            1. Second University of Naples, Italy
              1. Gianfranco Sinagra
              1. University of Trieste, Italy
                1. Aldo Dobrina
                1. University of Trieste, Italy
                  1. Fabio De Giorgio
                  1. Catholic University, Italy
                    1. Rishabh Sharma
                    1. VCU, United States
                      1. Fabio Bassan
                      1. University of Trieste, Italy
                        1. Anna Severino
                        1. Catholic University, Italy
                          1. Feliciano Baldi
                          1. Second University of Naples, Italy
                            1. Luigi M. Biasucci
                            1. Catholic University, Italy
                              1. Franco Pandolfi
                              1. Catholic University, Italy
                                1. Furio Silvestri
                                1. University of Trieste, Italy
                                  1. George W. Vetrovec
                                  1. VCU, United States
                                    1. Alfonso Baldi
                                    1. Second University of Naples, Italy
                                      1. Filippo Crea
                                      1. Catholic University, Italy

                                        Abstract

                                        Background. T-lymphocyte activation within atherosclerotic plaque, and widespread to the myocardium has been shown in patients with acute coronary syndromes.

                                        Aim To investigate the presence of T-lymphocyte infiltrate at different stages of acute coronary syndromes by studying patients with sudden coronary death, acute myocardial infarction and healed infarction, in comparison to patients with myocarditis and patients with non-ischemic heart failure.

                                        Methods. Seventy-two cases were studied at autopsy: 12 dying of sudden coronary death (Group 1), 12 dying <4 weeks (Group 2) and 12 dying >4 months after AMI (Group 3), 12 with active lymphocytic myocarditis (Group 4), 12 with hypertensive heart disease (Group 5), and 12 control subjects (Group 6). Light-microscopy was performed to measure the number of activated T-lymphocytes (CD3+/DR+) in the myocardium and coronary artery wall, and intercellular adhesion molecule-1 (ICAM-1) expression in the myocardium.

                                        Results. Activated T-lymphocyte infiltrates and ICAM-1 myocardial expression in both remote and peri-infarction regions and activated T lymphocytes within the epicardial coronary artery wall both the infarct- and non-infarct-related arteries were found in Groups 1,2 and 3, whereas myocardial, but not coronary, infiltrates were found in Groups 4 (P<0.001 vs Groups 1,2 and 3 for coronary infiltrates). Groups 5 and 6 had no evidence of myocardial or coronary inflammation (P<0.001 vs Groups 1,2 and 3).

                                        Conclusions. This study shows for the first time the presence of a lymphocytic infiltrate in both coronaries and myocardium and a pro-inflammatory phenotype shift in the myocardium associated with acute coronary thrombosis in patients dying suddenly, shortly, or even late after coronary thrombosis.

                                        • acute myocardial infarction
                                        • immune system
                                        • inflammation
                                        • lymphocyte
                                        • sudden death

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