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

Svenungsson, Elisabet ; Spaak, Jonas ; Strandberg, Karin LU ; Wallén, Håkan N. ; Agewall, Stefan ; Brolin, Elin B. ; Collste, Olov ; Daniel, Maria ; Ekenbäck, Christina and Frick, Mats , et al. (2022) In Journal of Internal Medicine 291(3). p.327-337
Abstract

Background: Recent studies demonstrate that prothrombotic antiphospholipid antibodies (aPL) are overrepresented in patients with myocardial infarction (MI) due to coronary artery disease (MICAD). However, it is not known whether aPL differ between the two subsets of MI: MICAD and MI with nonobstructive coronary arteries (MINOCA). Objectives: To determine whether aPL are associated with MINOCA or MICAD, or with hypercoagulability as assessed by activated protein C–protein C inhibitor (APC–PCI) complex. Methods: Well-characterized patients with MINOCA (n = 98), age- and gender-matched patients with MICAD (n = 99), and healthy controls (n = 100) were included in a cross-sectional case–control study. Autoantibodies (IgA/G/M) targeting... (More)

Background: Recent studies demonstrate that prothrombotic antiphospholipid antibodies (aPL) are overrepresented in patients with myocardial infarction (MI) due to coronary artery disease (MICAD). However, it is not known whether aPL differ between the two subsets of MI: MICAD and MI with nonobstructive coronary arteries (MINOCA). Objectives: To determine whether aPL are associated with MINOCA or MICAD, or with hypercoagulability as assessed by activated protein C–protein C inhibitor (APC–PCI) complex. Methods: Well-characterized patients with MINOCA (n = 98), age- and gender-matched patients with MICAD (n = 99), and healthy controls (n = 100) were included in a cross-sectional case–control study. Autoantibodies (IgA/G/M) targeting cardiolipin and β2glycoprotein-I and specific nuclear antigens were analyzed by multiplexed bead technology. The concentration of APC–PCI was determined as a measure of hypercoagulability by an immunofluorometric sandwich assay. Results: Both prevalence and titers of aPL of the IgG isotype (anti-cardiolipin and/or anti-β2glycoprotein-I) were higher in patients with MINOCA and MICAD than in controls. aPL IgG positivity was twice as frequent among patients with MICAD than MINOCA (11% vs. 6%, nonsignificant). We observed no group differences regarding aPL IgA/M or antibodies targeting specific nuclear antigens. Levels of APC–PCI were elevated in aPL IgG-positive compared to aPL IgG-negative MICAD patients. Conclusions: aPL IgG, but not IgA/M, are enriched particularly in patients with MICAD but also in patients with MINOCA, as compared to controls. Interestingly, signs of hypercoagulability—measured by increased levels of the APC–PCI complex—were present in aPL IgG-positive MICAD patients, indicating an association with functional disturbances of the coagulation system.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
antiphospholipid antibodies, arteriosclerosis, cardiovascular risk factors, coagulation, immunology, myocardial infarction
in
Journal of Internal Medicine
volume
291
issue
3
pages
327 - 337
publisher
Wiley-Blackwell
external identifiers
  • pmid:34820922
  • scopus:85120543910
ISSN
0954-6820
DOI
10.1111/joim.13409
language
English
LU publication?
yes
id
a4631876-0eb2-4a21-9901-27e46ae2081f
date added to LUP
2022-01-18 10:50:45
date last changed
2022-07-28 06:26:32
@article{a4631876-0eb2-4a21-9901-27e46ae2081f,
  abstract     = {{<p>Background: Recent studies demonstrate that prothrombotic antiphospholipid antibodies (aPL) are overrepresented in patients with myocardial infarction (MI) due to coronary artery disease (MICAD). However, it is not known whether aPL differ between the two subsets of MI: MICAD and MI with nonobstructive coronary arteries (MINOCA). Objectives: To determine whether aPL are associated with MINOCA or MICAD, or with hypercoagulability as assessed by activated protein C–protein C inhibitor (APC–PCI) complex. Methods: Well-characterized patients with MINOCA (n = 98), age- and gender-matched patients with MICAD (n = 99), and healthy controls (n = 100) were included in a cross-sectional case–control study. Autoantibodies (IgA/G/M) targeting cardiolipin and β<sub>2</sub>glycoprotein-I and specific nuclear antigens were analyzed by multiplexed bead technology. The concentration of APC–PCI was determined as a measure of hypercoagulability by an immunofluorometric sandwich assay. Results: Both prevalence and titers of aPL of the IgG isotype (anti-cardiolipin and/or anti-β<sub>2</sub>glycoprotein-I) were higher in patients with MINOCA and MICAD than in controls. aPL IgG positivity was twice as frequent among patients with MICAD than MINOCA (11% vs. 6%, nonsignificant). We observed no group differences regarding aPL IgA/M or antibodies targeting specific nuclear antigens. Levels of APC–PCI were elevated in aPL IgG-positive compared to aPL IgG-negative MICAD patients. Conclusions: aPL IgG, but not IgA/M, are enriched particularly in patients with MICAD but also in patients with MINOCA, as compared to controls. Interestingly, signs of hypercoagulability—measured by increased levels of the APC–PCI complex—were present in aPL IgG-positive MICAD patients, indicating an association with functional disturbances of the coagulation system.</p>}},
  author       = {{Svenungsson, Elisabet and Spaak, Jonas and Strandberg, Karin and Wallén, Håkan N. and Agewall, Stefan and Brolin, Elin B. and Collste, Olov and Daniel, Maria and Ekenbäck, Christina and Frick, Mats and Henareh, Loghman and Malmqvist, Karin and Elvin, Kerstin and Sörensson, Peder and Y-Hassan, Shams and Hofman-Bang, Claes and Tornvall, Per}},
  issn         = {{0954-6820}},
  keywords     = {{antiphospholipid antibodies; arteriosclerosis; cardiovascular risk factors; coagulation; immunology; myocardial infarction}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{327--337}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Journal of Internal Medicine}},
  title        = {{Antiphospholipid antibodies in patients with myocardial infarction with and without obstructive coronary arteries}},
  url          = {{http://dx.doi.org/10.1111/joim.13409}},
  doi          = {{10.1111/joim.13409}},
  volume       = {{291}},
  year         = {{2022}},
}