Frequency of Cholesterol Crystals in Culprit Coronary Artery Aspirate During Acute Myocardial Infarction and Their Relation to Inflammation and Myocardial Injury

George S. Abela, Jagadeesh K. Kalavakunta, Abed Janoudi, Dale Leffler, Gaurav Dhar, Negar Salehi, Joel Cohn, Ibrahim Shah, Milind Karve, Veera Pavan K. Kotaru, Vishal Gupta, Shukri David, Keerthy K. Narisetty, Michael Rich, Abigail Vanderberg, Dorothy R. Pathak, Fadi E. Shamoun

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Cholesterol crystals (CCs) have been associated with plaque rupture through mechanical injury and inflammation. This study evaluated the presence of CCs during acute myocardial infarction (AMI) and associated myocardial injury, inflammation, and arterial blood flow before and after percutaneous coronary intervention. Patients presenting with AMI (n = 286) had aspiration of culprit coronary artery obstruction. Aspirates were evaluated for crystal content, size, composition, and morphology by scanning electron microscopy, crystallography, and infrared spectroscopy. These were correlated with inflammatory biomarkers, cardiac enzymes, % coronary stenosis, and Thrombolysis in Myocardial Infarction (TIMI) blush and flow grades. Crystals were detected in 254 patients (89%) and confirmed to be cholesterol by spectroscopy. Of 286 patients 240 (84%) had CCs compacted into clusters that were large enough to be measured and analyzed. Moderate to extensive CC content was present in 172 cases (60%). Totally occluded arteries had significantly larger CC clusters than partially occluded arteries (p <0.05). Patients with CC cluster area >12,000 μm2 had significantly elevated interleukin-1 beta (IL-1β) levels (p <0.01), were less likely to have TIMI blush grade of 3 (p <0.01), and more likely to have TIMI flow grade of 1 (p <0.01). Patients with recurrent AMI had smaller CC cluster area (p <0.04), lower troponin (p <0.02), and IL-1β levels (p <0.04). Women had smaller CC clusters (p <0.04). Macrophages in the aspirates were found to be attached to CCs. Coronary artery aspirates had extensive deposits of CCs during AMI. In conclusion, presence of large CC clusters was associated with increased inflammation (IL-1β), increased arterial narrowing, and diminished reflow following percutaneous coronary intervention.

Original languageEnglish (US)
JournalAmerican Journal of Cardiology
DOIs
StateAccepted/In press - 2017

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Coronary Vessels
Myocardial Infarction
Cholesterol
Inflammation
Wounds and Injuries
Interleukin-1beta
Percutaneous Coronary Intervention
Spectrum Analysis
Arteries
Arteritis
Crystallography
Troponin
Coronary Stenosis
Electron Scanning Microscopy
Rupture
Biomarkers
Macrophages
Enzymes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Frequency of Cholesterol Crystals in Culprit Coronary Artery Aspirate During Acute Myocardial Infarction and Their Relation to Inflammation and Myocardial Injury. / Abela, George S.; Kalavakunta, Jagadeesh K.; Janoudi, Abed; Leffler, Dale; Dhar, Gaurav; Salehi, Negar; Cohn, Joel; Shah, Ibrahim; Karve, Milind; Kotaru, Veera Pavan K.; Gupta, Vishal; David, Shukri; Narisetty, Keerthy K.; Rich, Michael; Vanderberg, Abigail; Pathak, Dorothy R.; Shamoun, Fadi E.

In: American Journal of Cardiology, 2017.

Research output: Contribution to journalArticle

Abela, GS, Kalavakunta, JK, Janoudi, A, Leffler, D, Dhar, G, Salehi, N, Cohn, J, Shah, I, Karve, M, Kotaru, VPK, Gupta, V, David, S, Narisetty, KK, Rich, M, Vanderberg, A, Pathak, DR & Shamoun, FE 2017, 'Frequency of Cholesterol Crystals in Culprit Coronary Artery Aspirate During Acute Myocardial Infarction and Their Relation to Inflammation and Myocardial Injury', American Journal of Cardiology. https://doi.org/10.1016/j.amjcard.2017.07.075
Abela, George S. ; Kalavakunta, Jagadeesh K. ; Janoudi, Abed ; Leffler, Dale ; Dhar, Gaurav ; Salehi, Negar ; Cohn, Joel ; Shah, Ibrahim ; Karve, Milind ; Kotaru, Veera Pavan K. ; Gupta, Vishal ; David, Shukri ; Narisetty, Keerthy K. ; Rich, Michael ; Vanderberg, Abigail ; Pathak, Dorothy R. ; Shamoun, Fadi E. / Frequency of Cholesterol Crystals in Culprit Coronary Artery Aspirate During Acute Myocardial Infarction and Their Relation to Inflammation and Myocardial Injury. In: American Journal of Cardiology. 2017.
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abstract = "Cholesterol crystals (CCs) have been associated with plaque rupture through mechanical injury and inflammation. This study evaluated the presence of CCs during acute myocardial infarction (AMI) and associated myocardial injury, inflammation, and arterial blood flow before and after percutaneous coronary intervention. Patients presenting with AMI (n = 286) had aspiration of culprit coronary artery obstruction. Aspirates were evaluated for crystal content, size, composition, and morphology by scanning electron microscopy, crystallography, and infrared spectroscopy. These were correlated with inflammatory biomarkers, cardiac enzymes, {\%} coronary stenosis, and Thrombolysis in Myocardial Infarction (TIMI) blush and flow grades. Crystals were detected in 254 patients (89{\%}) and confirmed to be cholesterol by spectroscopy. Of 286 patients 240 (84{\%}) had CCs compacted into clusters that were large enough to be measured and analyzed. Moderate to extensive CC content was present in 172 cases (60{\%}). Totally occluded arteries had significantly larger CC clusters than partially occluded arteries (p <0.05). Patients with CC cluster area >12,000 μm2 had significantly elevated interleukin-1 beta (IL-1β) levels (p <0.01), were less likely to have TIMI blush grade of 3 (p <0.01), and more likely to have TIMI flow grade of 1 (p <0.01). Patients with recurrent AMI had smaller CC cluster area (p <0.04), lower troponin (p <0.02), and IL-1β levels (p <0.04). Women had smaller CC clusters (p <0.04). Macrophages in the aspirates were found to be attached to CCs. Coronary artery aspirates had extensive deposits of CCs during AMI. In conclusion, presence of large CC clusters was associated with increased inflammation (IL-1β), increased arterial narrowing, and diminished reflow following percutaneous coronary intervention.",
author = "Abela, {George S.} and Kalavakunta, {Jagadeesh K.} and Abed Janoudi and Dale Leffler and Gaurav Dhar and Negar Salehi and Joel Cohn and Ibrahim Shah and Milind Karve and Kotaru, {Veera Pavan K.} and Vishal Gupta and Shukri David and Narisetty, {Keerthy K.} and Michael Rich and Abigail Vanderberg and Pathak, {Dorothy R.} and Shamoun, {Fadi E.}",
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T1 - Frequency of Cholesterol Crystals in Culprit Coronary Artery Aspirate During Acute Myocardial Infarction and Their Relation to Inflammation and Myocardial Injury

AU - Abela, George S.

AU - Kalavakunta, Jagadeesh K.

AU - Janoudi, Abed

AU - Leffler, Dale

AU - Dhar, Gaurav

AU - Salehi, Negar

AU - Cohn, Joel

AU - Shah, Ibrahim

AU - Karve, Milind

AU - Kotaru, Veera Pavan K.

AU - Gupta, Vishal

AU - David, Shukri

AU - Narisetty, Keerthy K.

AU - Rich, Michael

AU - Vanderberg, Abigail

AU - Pathak, Dorothy R.

AU - Shamoun, Fadi E.

PY - 2017

Y1 - 2017

N2 - Cholesterol crystals (CCs) have been associated with plaque rupture through mechanical injury and inflammation. This study evaluated the presence of CCs during acute myocardial infarction (AMI) and associated myocardial injury, inflammation, and arterial blood flow before and after percutaneous coronary intervention. Patients presenting with AMI (n = 286) had aspiration of culprit coronary artery obstruction. Aspirates were evaluated for crystal content, size, composition, and morphology by scanning electron microscopy, crystallography, and infrared spectroscopy. These were correlated with inflammatory biomarkers, cardiac enzymes, % coronary stenosis, and Thrombolysis in Myocardial Infarction (TIMI) blush and flow grades. Crystals were detected in 254 patients (89%) and confirmed to be cholesterol by spectroscopy. Of 286 patients 240 (84%) had CCs compacted into clusters that were large enough to be measured and analyzed. Moderate to extensive CC content was present in 172 cases (60%). Totally occluded arteries had significantly larger CC clusters than partially occluded arteries (p <0.05). Patients with CC cluster area >12,000 μm2 had significantly elevated interleukin-1 beta (IL-1β) levels (p <0.01), were less likely to have TIMI blush grade of 3 (p <0.01), and more likely to have TIMI flow grade of 1 (p <0.01). Patients with recurrent AMI had smaller CC cluster area (p <0.04), lower troponin (p <0.02), and IL-1β levels (p <0.04). Women had smaller CC clusters (p <0.04). Macrophages in the aspirates were found to be attached to CCs. Coronary artery aspirates had extensive deposits of CCs during AMI. In conclusion, presence of large CC clusters was associated with increased inflammation (IL-1β), increased arterial narrowing, and diminished reflow following percutaneous coronary intervention.

AB - Cholesterol crystals (CCs) have been associated with plaque rupture through mechanical injury and inflammation. This study evaluated the presence of CCs during acute myocardial infarction (AMI) and associated myocardial injury, inflammation, and arterial blood flow before and after percutaneous coronary intervention. Patients presenting with AMI (n = 286) had aspiration of culprit coronary artery obstruction. Aspirates were evaluated for crystal content, size, composition, and morphology by scanning electron microscopy, crystallography, and infrared spectroscopy. These were correlated with inflammatory biomarkers, cardiac enzymes, % coronary stenosis, and Thrombolysis in Myocardial Infarction (TIMI) blush and flow grades. Crystals were detected in 254 patients (89%) and confirmed to be cholesterol by spectroscopy. Of 286 patients 240 (84%) had CCs compacted into clusters that were large enough to be measured and analyzed. Moderate to extensive CC content was present in 172 cases (60%). Totally occluded arteries had significantly larger CC clusters than partially occluded arteries (p <0.05). Patients with CC cluster area >12,000 μm2 had significantly elevated interleukin-1 beta (IL-1β) levels (p <0.01), were less likely to have TIMI blush grade of 3 (p <0.01), and more likely to have TIMI flow grade of 1 (p <0.01). Patients with recurrent AMI had smaller CC cluster area (p <0.04), lower troponin (p <0.02), and IL-1β levels (p <0.04). Women had smaller CC clusters (p <0.04). Macrophages in the aspirates were found to be attached to CCs. Coronary artery aspirates had extensive deposits of CCs during AMI. In conclusion, presence of large CC clusters was associated with increased inflammation (IL-1β), increased arterial narrowing, and diminished reflow following percutaneous coronary intervention.

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