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Published on: September 3, 2020
[Polymorphonuclear neutrophils in myocardial ischemia and reperfusion injury. Influence of coronary intervention?]
Andreas Link1, Holger Schwerdt, Benno Hennen
1Medizinische Klinik und Poliklinik, Innere Medizin III Universitätskliniken des Saarlandes, 66421 Homburg/Saar, Germany. andreas.link@telemed.de
Unlabelled:
Circulating polymorphonuclear neutrophils (PMNs) are known to contribute to the pathophysiology of myocardial ischemia and reperfusion injury. The present study was designed to examine whether the duration of ischemia in myocardial infarction, the type of coronary intervention (angioplasty vs. angioplasty plus stenting) and duration of the procedure itself modulate the inflammatory responses of PMNs.
Methods And Results:
In patients with acute myocardial infarction (AMI; n = 20) neutrophil beta-2-integrin Mac-1 (CD11b/CD18) and L-selectin (CD62L) were determined at different time points before and after PTCA or PTCA plus stenting. After PTCA alone but not after PTCA plus stenting a significant rise in Mac-1 (136 +/- 43%) was demonstrated. This elevation decreased after 60 minutes if the duration of the recanalization procedure was shorter than 30 minutes but remained elevated after longer interventions. After delayed intervention a significant and more pronounced increase of Mac-1 (142 +/- 37%) was observed, while early intervention prevented this increase. After PTCA alone or delayed intervention a significant shedding of L-selectin (77 +/- 20%; 77 +/- 23%) was demonstrated. Early intervention or PTCA plus stenting caused no significant changes in L-selectin.
Conclusions:
It is concluded that PMN activation is attenuated by early and short intervention as well as by stenting. Induction of PMN activation might contribute to the superior outcome following stenting and early intervention compared to conventional PTCA in particular when performed delayed.
Insights
Early and short coronary interventions, especially with stenting, reduce polymorphonuclear neutrophil (PMN) activation in myocardial infarction patients. This attenuation of PMN response may explain better outcomes with stenting and timely procedures.
Area of Science:
- Cardiovascular Medicine
- Immunology
- Interventional Cardiology
Background:
- Polymorphonuclear neutrophils (PMNs) play a role in myocardial ischemia and reperfusion injury.
- Understanding PMN inflammatory responses is crucial for optimizing acute myocardial infarction (AMI) treatment.
Purpose of the Study:
- To investigate how ischemia duration, coronary intervention type (PTCA vs. PTCA plus stenting), and procedure length affect PMN inflammatory responses in AMI patients.
Main Methods:
- Measured neutrophil beta-2-integrin Mac-1 and L-selectin in 20 AMI patients before and after percutaneous transluminal coronary angioplasty (PTCA) or PTCA plus stenting.
- Analyzed changes based on intervention timing (early vs. delayed) and procedure duration.
Main Results:
- PTCA alone, particularly when delayed or prolonged, significantly increased Mac-1 expression and L-selectin shedding.
- PTCA plus stenting and early, short interventions attenuated these PMN activation markers.
- Early intervention prevented the significant increase in Mac-1 observed after delayed procedures.
Conclusions:
- PMN activation is significantly reduced by early, short coronary interventions and by the use of stenting.
- Attenuated PMN activation likely contributes to the improved clinical outcomes observed with stenting and early intervention compared to delayed conventional PTCA.
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