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Antiphospholipid antibodies in patients with myocardial infarction with and without obstructive coronary arteries

Elisabet Svenungsson1, Jonas Spaak2, Karin Strandberg3

  • 1Department of Medicine, Solna, Division of Rheumatology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.

Journal of Internal Medicine
|November 25, 2021
PubMed

Insights

Antiphospholipid antibodies (aPL) IgG are linked to myocardial infarction (MI) in both obstructive (MICAD) and non-obstructive (MINOCA) coronary artery disease. These antibodies, particularly in MICAD, correlate with hypercoagulability, suggesting a role in clotting disorders.

Area of Science:

  • Cardiology
  • Immunology
  • Hematology

Background:

  • Prothrombotic antiphospholipid antibodies (aPL) are linked to myocardial infarction (MI) from coronary artery disease (MICAD).
  • It remains unclear if aPL differ between MICAD and MI with nonobstructive coronary arteries (MINOCA).

Purpose of the Study:

  • To investigate the association of aPL with MINOCA and MICAD.
  • To assess if aPL correlate with hypercoagulability, measured by activated protein C-protein C inhibitor (APC-PCI) complex.

Main Methods:

  • Cross-sectional case-control study including 98 MINOCA patients, 99 MICAD patients, and 100 controls.
  • Analysis of IgA/G/M autoantibodies against cardiolipin and β2 glycoprotein-I using multiplexed bead technology.
  • Quantification of APC-PCI complex levels to assess hypercoagulability.

Main Results:

  • Prevalence and titers of IgG aPL (anti-cardiolipin and/or anti-β2 glycoprotein-I) were higher in both MINOCA and MICAD patients compared to controls.
  • aPL IgG positivity was more frequent in MICAD (11%) than MINOCA (6%), though not statistically significant.
  • Elevated APC-PCI levels were observed in aPL IgG-positive MICAD patients, indicating hypercoagulability.

Conclusions:

  • IgG aPL are enriched in both MICAD and MINOCA patients compared to controls, with a particular enrichment in MICAD.
  • Increased APC-PCI levels in aPL IgG-positive MICAD patients suggest a functional link to coagulation system disturbances.
Abstract

Keywords:
antiphospholipid antibodiesarteriosclerosiscardiovascular risk factorscoagulationimmunologymyocardial infarction

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