title: Bacterial signatures in thrombus aspirates of patients with myocardial infarction.
abstract: BACKGROUND
  Infectious agents, especially bacteria and their components originating from the oral cavity or respiratory tract, have been suggested to contribute to inflammation in the coronary plaque, leading to rupture and the subsequent development of coronary thrombus. We aimed to measure bacterial DNA in thrombus aspirates of patients with ST-segment-elevation myocardial infarction and to check for a possible association between bacteria findings and oral pathology in the same cohort.
  
  
  RESULTS
  Thrombus aspirates and arterial blood from patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention (n=101; 76% male; mean age, 63.3 years) were analyzed with real-time quantitative polymerase chain reaction with specific primers and probes to detect bacterial DNA from several oral species and Chlamydia pneumoniae. The median value for the total amount of bacterial DNA in thrombi was 16 times higher than that found in their blood samples. Bacterial DNA typical for endodontic infection, mainly oral viridans streptococci, was measured in 78.2% of thrombi, and periodontal pathogens were measured in 34.7%. Bacteria-like structures were detected by transmission electron microscopy in all 9 thrombus samples analyzed; whole bacteria were detected in 3 of 9 cases. Monocyte/macrophage markers for bacteria recognition (CD14) and inflammation (CD68) were detected in thrombi (8 of 8) by immunohistochemistry. Among the subgroup of 30 patients with myocardial infarction examined by panoramic tomography, a significant association between the presence of periapical abscesses and oral viridans streptococci DNA-positive thrombi was found (odds ratio, 13.2; 95% confidence interval, 2.11-82.5; P=0.004).
  
  
  CONCLUSIONS
  Dental infection and oral bacteria, especially viridans streptococci, may be associated with the development of acute coronary thrombosis.
authors: Department of Forensic Science, School of Medicine, FIN-33014 Tampere University, Finland. tanja.pessi@uta.fi
authors: Tanja
authors: T
authors: Pessi
authors: Vesa
authors: V
authors: Karhunen
authors: Pasi P
authors: PP
authors: Karjalainen
authors: Antti
authors: A
authors: Ylitalo
authors: Juhani K
authors: JK
authors: Airaksinen
authors: Matti
authors: M
authors: Niemi
authors: Mikko
authors: M
authors: Pietila
authors: Kari
authors: K
authors: Lounatmaa
authors: Teppo
authors: T
authors: Haapaniemi
authors: Terho
authors: T
authors: Lehtimäki
authors: Reijo
authors: R
authors: Laaksonen
authors: Pekka J
authors: PJ
authors: Karhunen
authors: Jussi
authors: J
authors: Mikkelsson
mesh_terms: D015703:Antigens, CD / Q000378:metabolism; D015214:Antigens, Differentiation, Myelomonocytic / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism; D001707:Biopsy, Needle; D004269:DNA, Bacterial / Q000378:metabolism; D005260:Female; D006801:Humans; D018950:Lipopolysaccharide Receptors / Q000378:metabolism; D008264:Macrophages / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009059:Mouth Diseases / Q000150:complications* / Q000382:microbiology; D009203:Myocardial Infarction / Q000209:etiology*; D012189:Retrospective Studies; D009057:Stomatognathic Diseases / Q000150:complications* / Q000382:microbiology; D013927:Thrombosis / Q000150:complications / Q000382:microbiology* / Q000473:pathology*; D034363:Viridans Streptococci / Q000235:genetics / Q000302:isolation & purification*; D000097382:CD68 Molecule
chemical_list: D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D015415:Biomarkers; D004269:DNA, Bacterial; D018950:Lipopolysaccharide Receptors; C067980:CD68 antigen, human; D000097382:CD68 Molecule