tetano
Editor, Senior Moderator
JAMA Cardiol
. 2020 Dec 29.
doi: 10.1001/jamacardio.2020.7308. Online ahead of print.
Assessment of Neutrophil Extracellular Traps in Coronary Thrombus of a Case Series of Patients With COVID-19 and Myocardial Infarction
Ana Blasco[SUP] 1 [/SUP], Mar?a-Jos? Coronado[SUP] 2 [/SUP], Fernando Hern?ndez-Terciado[SUP] 1 [/SUP], Paloma Mart?n[SUP] 3 4 [/SUP], Ana Royuela[SUP] 5 6 [/SUP], Elvira Ramil[SUP] 7 [/SUP], Diego Garc?a[SUP] 3 [/SUP], Javier Goicolea[SUP] 1 [/SUP], Mar?a Del Trigo[SUP] 1 [/SUP], Javier Ortega[SUP] 1 [/SUP], Juan M Escudier[SUP] 1 [/SUP], Lorenzo Silva[SUP] 1 [/SUP], Carmen Bellas[SUP] 3 4 [/SUP]
Affiliations
Abstract
Importance: Severe coronavirus disease 2019 (COVID-19) is characterized by the intense formation of neutrophil extracellular traps (NETs), leading to the occlusion of microvessels, as shown in pulmonary samples. The occurrence of ST-elevated myocardial infarction (STEMI) is a serious cardiac manifestation of COVID-19; the intrinsic mechanism of coronary thrombosis appears to still be unknown.
Objective: To determine the role of NETs in coronary thrombosis in patients with COVID-19.
Design, setting, and participants: This was a consecutive series of patients with COVID-19 at an academic tertiary hospital in Madrid, Spain, who underwent primary coronary interventions for STEMI in which coronary aspirates were obtained in the catheterization laboratory using a thrombus aspiration device. Patients with COVID-19 who experienced a STEMI between March 23 and April 11, 2020, from whom coronary thrombus samples were aspirated during primary coronary intervention, were included in the analysis. These patients were compared with a series conducted from July 2015 to December 2015 of patients with STEMI.
Main outcomes and measures: The presence and quantity of NETs in coronary aspirates from patients with STEMI and COVID-19. The method for the analysis of NETs in paraffin-embedded coronary thrombi was based on the use of confocal microscopy technology and image analysis for the colocalization of myeloperoxidase-DNA complexes and citrullinated histone H3. Immunohistochemical analysis of thrombi was also performed. Clinical and angiographic variables were prospectively collected.
Results: Five patients with COVID-19 were included (4 men [80%]; mean [SD] age, 62 [14] years); the comparison group included 50 patients (44 males [88%]; mean [SD] age, 58 [12] years). NETs were detected in the samples of all 5 patients with COVID-19, and the median density of NETs was 61% (95% CI, 43%-91%). In the historical series of patients with STEMI, NETs were found in 34 of 50 thrombi (68%), and the median NET density was 19% (95% CI, 13%-22%; P < .001). All thrombi from patients with COVID-19 were composed of fibrin and polymorphonuclear cells. None of them showed fragments of atherosclerotic plaque or iron deposits indicative of previous episodes of plaque rupture.
Conclusions and relevance: In this small case series of patients with COVID-19 and myocardial infarction, NETs seem to play a major role in the pathogenesis of STEMI in COVID-19 disease. Our findings support the idea that targeting intravascular NETs might be a relevant goal of treatment and a feasible way to prevent coronary thrombosis in patients with severe COVID-19 disease.
. 2020 Dec 29.
doi: 10.1001/jamacardio.2020.7308. Online ahead of print.
Assessment of Neutrophil Extracellular Traps in Coronary Thrombus of a Case Series of Patients With COVID-19 and Myocardial Infarction
Ana Blasco[SUP] 1 [/SUP], Mar?a-Jos? Coronado[SUP] 2 [/SUP], Fernando Hern?ndez-Terciado[SUP] 1 [/SUP], Paloma Mart?n[SUP] 3 4 [/SUP], Ana Royuela[SUP] 5 6 [/SUP], Elvira Ramil[SUP] 7 [/SUP], Diego Garc?a[SUP] 3 [/SUP], Javier Goicolea[SUP] 1 [/SUP], Mar?a Del Trigo[SUP] 1 [/SUP], Javier Ortega[SUP] 1 [/SUP], Juan M Escudier[SUP] 1 [/SUP], Lorenzo Silva[SUP] 1 [/SUP], Carmen Bellas[SUP] 3 4 [/SUP]
Affiliations
- PMID: 33372956
- DOI: 10.1001/jamacardio.2020.7308
Abstract
Importance: Severe coronavirus disease 2019 (COVID-19) is characterized by the intense formation of neutrophil extracellular traps (NETs), leading to the occlusion of microvessels, as shown in pulmonary samples. The occurrence of ST-elevated myocardial infarction (STEMI) is a serious cardiac manifestation of COVID-19; the intrinsic mechanism of coronary thrombosis appears to still be unknown.
Objective: To determine the role of NETs in coronary thrombosis in patients with COVID-19.
Design, setting, and participants: This was a consecutive series of patients with COVID-19 at an academic tertiary hospital in Madrid, Spain, who underwent primary coronary interventions for STEMI in which coronary aspirates were obtained in the catheterization laboratory using a thrombus aspiration device. Patients with COVID-19 who experienced a STEMI between March 23 and April 11, 2020, from whom coronary thrombus samples were aspirated during primary coronary intervention, were included in the analysis. These patients were compared with a series conducted from July 2015 to December 2015 of patients with STEMI.
Main outcomes and measures: The presence and quantity of NETs in coronary aspirates from patients with STEMI and COVID-19. The method for the analysis of NETs in paraffin-embedded coronary thrombi was based on the use of confocal microscopy technology and image analysis for the colocalization of myeloperoxidase-DNA complexes and citrullinated histone H3. Immunohistochemical analysis of thrombi was also performed. Clinical and angiographic variables were prospectively collected.
Results: Five patients with COVID-19 were included (4 men [80%]; mean [SD] age, 62 [14] years); the comparison group included 50 patients (44 males [88%]; mean [SD] age, 58 [12] years). NETs were detected in the samples of all 5 patients with COVID-19, and the median density of NETs was 61% (95% CI, 43%-91%). In the historical series of patients with STEMI, NETs were found in 34 of 50 thrombi (68%), and the median NET density was 19% (95% CI, 13%-22%; P < .001). All thrombi from patients with COVID-19 were composed of fibrin and polymorphonuclear cells. None of them showed fragments of atherosclerotic plaque or iron deposits indicative of previous episodes of plaque rupture.
Conclusions and relevance: In this small case series of patients with COVID-19 and myocardial infarction, NETs seem to play a major role in the pathogenesis of STEMI in COVID-19 disease. Our findings support the idea that targeting intravascular NETs might be a relevant goal of treatment and a feasible way to prevent coronary thrombosis in patients with severe COVID-19 disease.