title: Allergic Inflammation Is Associated With Coronary Instability and a Worse Clinical Outcome After Acute Myocardial Infarction.
abstract: BACKGROUND
  The role of allergic inflammation in acute coronary syndromes (ACS) has not been clearly defined to date. Aim of this study was to assess eosinophil and basophil activation in ACS and the prognostic role of eosinophil cationic protein in ST-segment-elevation myocardial infarction.
  
  
  RESULTS
  In a cross-sectional study, we prospectively enrolled 51 patients undergoing percutaneous coronary intervention (60.8% patients with ACS and 39.2% with stable angina). Flow cytometry analysis assessed CD66b, CD69, and CD203c median fluorescence intensity expression. In a follow-up study, 181 patients presenting with ST-segment-elevation myocardial infarction, undergoing primary percutaneous coronary intervention, were prospectively enrolled with a follow-up of 24 months. Eosinophil activation (CD66b) was similar in patients with ACS and stable angina (6.61 [4.91-7.72] versus 6.62 [5.27-8.73], P=0.63), whereas eosinophil degranulation (CD69) and basophil activation (CD203c) were higher in ACS patients compared with stable angina patients (1.38 [1.16-1.52] versus 1.17 [1-1.31], P=0.01); 0.97 [0.89-1.11] versus 0.92 [0.87-0.95], P=0.03, respectively). Eosinophil cationic protein serum levels were significantly higher in ST-segment-elevation myocardial infarction patients with major adverse cardiac events as compared with those without (21.1 [10.37-25.65] versus 7.83 [3.37-12.8] μg/L, P=0.01) and in patients with thrombus score >3 compared with those with thrombus score ≤3 (15.0 [9.8-24.7] versus 5.2 [3.5-22.9] μg/L, P=0.006). Eosinophil cationic protein serum levels predicted major adverse cardiac events during follow-up (odds ratio =1.041, 95% confidence interval 1.012-1.071, P=0.005). C-reactive protein serum levels showed a borderline statistical significance (odds ratio =0.904, 95% confidence interval 0.806-1.014, P=0.085).
  
  
  CONCLUSIONS
  These findings are the first demonstration of in vivo eosinophil degranulation and basophil activation during ACS and of the prognostic role of eosinophil cationic protein in ST-segment-elevation myocardial infarction.
authors.affiliation: From the Department of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (G.N., G.S., G.L., F.C.); Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy (C.C.); Institute of Allergology, Catholic University of the Sacred Heart, Rome, Italy (D.F., D.S.); Department of Epidemiology of Chronic Non-Communicable Diseases, Federal State Institution National Research Center for Preventive Medicine, Moscow, Russia (A.I.); and Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Belgium (V.S.). gniccoli73@hotmail.it.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Niccoli
authors.affiliation: From the Department of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (G.N., G.S., G.L., F.C.); Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy (C.C.); Institute of Allergology, Catholic University of the Sacred Heart, Rome, Italy (D.F., D.S.); Department of Epidemiology of Chronic Non-Communicable Diseases, Federal State Institution National Research Center for Preventive Medicine, Moscow, Russia (A.I.); and Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Belgium (V.S.).
authors.forename: Camilla
authors.initials: C
authors.lastname: Calvieri
authors.affiliation: From the Department of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (G.N., G.S., G.L., F.C.); Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy (C.C.); Institute of Allergology, Catholic University of the Sacred Heart, Rome, Italy (D.F., D.S.); Department of Epidemiology of Chronic Non-Communicable Diseases, Federal State Institution National Research Center for Preventive Medicine, Moscow, Russia (A.I.); and Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Belgium (V.S.).
authors.forename: Davide
authors.initials: D
authors.lastname: Flego
authors.affiliation: From the Department of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (G.N., G.S., G.L., F.C.); Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy (C.C.); Institute of Allergology, Catholic University of the Sacred Heart, Rome, Italy (D.F., D.S.); Department of Epidemiology of Chronic Non-Communicable Diseases, Federal State Institution National Research Center for Preventive Medicine, Moscow, Russia (A.I.); and Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Belgium (V.S.).
authors.forename: Giancarla
authors.initials: G
authors.lastname: Scalone
authors.affiliation: From the Department of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (G.N., G.S., G.L., F.C.); Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy (C.C.); Institute of Allergology, Catholic University of the Sacred Heart, Rome, Italy (D.F., D.S.); Department of Epidemiology of Chronic Non-Communicable Diseases, Federal State Institution National Research Center for Preventive Medicine, Moscow, Russia (A.I.); and Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Belgium (V.S.).
authors.forename: Asya
authors.initials: A
authors.lastname: Imaeva
authors.affiliation: From the Department of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (G.N., G.S., G.L., F.C.); Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy (C.C.); Institute of Allergology, Catholic University of the Sacred Heart, Rome, Italy (D.F., D.S.); Department of Epidemiology of Chronic Non-Communicable Diseases, Federal State Institution National Research Center for Preventive Medicine, Moscow, Russia (A.I.); and Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Belgium (V.S.).
authors.forename: Vito
authors.initials: V
authors.lastname: Sabato
authors.affiliation: From the Department of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (G.N., G.S., G.L., F.C.); Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy (C.C.); Institute of Allergology, Catholic University of the Sacred Heart, Rome, Italy (D.F., D.S.); Department of Epidemiology of Chronic Non-Communicable Diseases, Federal State Institution National Research Center for Preventive Medicine, Moscow, Russia (A.I.); and Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Belgium (V.S.).
authors.forename: Domenico
authors.initials: D
authors.lastname: Schiavino
authors.affiliation: From the Department of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (G.N., G.S., G.L., F.C.); Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy (C.C.); Institute of Allergology, Catholic University of the Sacred Heart, Rome, Italy (D.F., D.S.); Department of Epidemiology of Chronic Non-Communicable Diseases, Federal State Institution National Research Center for Preventive Medicine, Moscow, Russia (A.I.); and Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Belgium (V.S.).
authors.forename: Giovanna
authors.initials: G
authors.lastname: Liuzzo
authors.affiliation: From the Department of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (G.N., G.S., G.L., F.C.); Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy (C.C.); Institute of Allergology, Catholic University of the Sacred Heart, Rome, Italy (D.F., D.S.); Department of Epidemiology of Chronic Non-Communicable Diseases, Federal State Institution National Research Center for Preventive Medicine, Moscow, Russia (A.I.); and Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Belgium (V.S.).
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
mesh_terms: D054058:Acute Coronary Syndrome / Q000276:immunology; D000368:Aged; D000369:Aged, 80 and over; D060050:Angina, Stable / Q000276:immunology; D001491:Basophils / Q000276:immunology*; D002097:C-Reactive Protein / Q000378:metabolism; D017023:Coronary Angiography; D003430:Cross-Sectional Studies; D004452:Echocardiography; D047150:Eosinophil Cationic Protein / Q000097:blood; D004804:Eosinophils / Q000276:immunology*; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D007249:Inflammation / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D002097:C-Reactive Protein; D047150:Eosinophil Cationic Protein
keywords: acute coronary syndrome; allergic cells; inflammation