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Updated: Feb 13, 2026
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Circulating microparticles are associated with clinical severity of persistent ST-segment elevation myocardial
A Sionis1, R Suades2, J Sans-Roselló3
1Acute and Intensive Cardiac Care Unit, Cardiology Department, Hospital Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; CiberCV, Institute of Health Carlos III, Hospital Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
Insights
Cardiogenic shock (CS) patients exhibit elevated levels of circulating microparticles (cMPs) from activated leukocytes and platelets. This cMP signature can identify CS patients and predict mortality, aiding in risk stratification and improved patient outcomes.
Area of Science:
- Cardiovascular Medicine
- Biomarkers
- Cellular Biology
Background:
- Cardiogenic shock (CS) is a severe complication of acute myocardial infarction (MI), associated with high mortality despite advancements in treatment.
- The role of circulating microparticles (cMPs) as potential biomarkers in CS remains largely unexplored.
- Investigating cMP subtypes may offer insights into cellular activation and damage in CS patients.
Purpose of the Study:
- To investigate circulating microparticle (cMP) subtypes and their parental activated cells in ST-elevation myocardial infarction (STEMI) patients with and without cardiogenic shock (CS).
- To identify a cMP signature that can aid in the risk stratification of CS patients.
- To explore the association of specific cMPs with clinical outcomes and myocardial reperfusion in CS.
Main Methods:
- Triple-labeling flow cytometry was used to characterize cMPs in STEMI patients with and without CS (36 patients per group).
- Patients received guideline-directed medical therapy, including primary percutaneous coronary intervention.
- cMPs were analyzed for their origin from platelets, leukocytes (neutrophils, granulocytes, monocytes), and endothelium.
Main Results:
- CS patients showed significantly increased levels of leukocyte-derived (neutrophil, granulocyte) and platelet-derived cMPs compared to non-CS patients.
- A distinct cMP signature comprising platelet, leukocyte, and endothelial microparticles effectively discriminated CS patients (AUC 0.743) and predicted mortality (AUC 0.869).
- In CS patients, elevated platelet-, monocyte-, and tissue factor-rich cMPs correlated with poorer myocardial reperfusion (blush grade, TIMI flow).
Conclusions:
- Elevated levels of prothrombotic and proinflammatory cMPs are characteristic of CS patients.
- Activated granulocytes and neutrophils continuously release cMPs in CS patients, even with guideline-directed treatment.
- These cMPs serve as valuable biomarkers for adverse prognosis in cardiogenic shock, potentially guiding clinical management.
Background:
Cardiogenic shock (CS) is the leading cause of death in patients admitted for acute myocardial infarction (MI). Despite the recent advances in reperfusion and medical treatment mortality remains unacceptably high. Whether cells of the blood compartment in CS-patients are activated and release microparticles (cMPs) that may be both messengers and biomarkers of cell damage is not known. We aimed to investigate the cMP subtypes and parental activated cells of ST-elevation MI (STEMI)-patients complicated by CS and that of non-CS STEMI-patients (non-CS) in order to identify a cMP signature that could aid CS patient's risk stratification.
Methods:
Clinically-characterized STEMI-patients with and without CS (36/group) were included. Treatment was delivered according to guidelines and included primary percutaneous coronary intervention. cMPs were characterized by triple-labeling flow cytometry using Annexin V and cell surface-specific monoclonal antibodies.
Results:
Increased levels of leukocyte-derived (neutrophil and granulocyte origin) and platelet-derived cMPs were detected in CS compared to non-CS patients. A signature of cMPs derived from platelets, leukocytes, and endothelium discriminated CS-patients (AUC of 0.743±0.059 [95% CI: 0.628-0.859], P<0.0001) and predicted mortality in CS (AUC of 0.869±0.06 [95% CI: 0.750-0.988], P<0.0001). In CS-patients, a higher number of platelet- and monocyte-cMPs and of tissue factor-rich cMPs associated to worse myocardial blush grade and thrombolysis in myocardial infarction flow.
Conclusions:
cMPs derived from proinflammatory and prothrombotic cells were found to be elevated in CS-patients. In treated as per guidelines CS patients, granulocytes and neutrophils remained activated and actively shed cMPs. These cMPs were biomarkers of adverse prognosis in CS.
Translational Aspect:
Increased levels of leukocyte and platelet-derived circulating microparticles (cMPs) are found in cardiogenic shock (CS) patients as compared to non-CS patients. In CS-patients, a higher number of platelet- and monocyte-cMPs and a higher number of tissue factor-rich cMPs were associated to worse myocardial reperfusion. A specific prothrombotic and proinflammatory cMPs signature in cardiogenic shock (CS) patients is a potential discriminator and survival prognostic biomarker for CS, which could aid management and improve clinical outcomes.
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