Local Matrix Metalloproteinase 9 Level Determines Early Clinical Presentation of ST-Segment-Elevation Myocardial Infarction.
Early clinical presentation of ST-segment-elevation myocardial infarction (STEMI) and non-ST-segment-elevation myocardial infarction affects patient management. Although local inflammatory activities are involved in the onset of MI, little is known about their impact on early clinical presentation. This study aimed to investigate whether local inflammatory activities affect early clinical presentation.



This study comprised 94 and 17 patients with MI (STEMI, 69; non-STEMI, 25) and stable angina pectoris, respectively. We simultaneously investigated the culprit lesion morphologies using optical coherence tomography and inflammatory activities assessed by shedding matrix metalloproteinase 9 (MMP-9) and myeloperoxidase into the coronary circulation before and after stenting. Prevalence of plaque rupture, thin-cap fibroatheroma, and lipid arc or macrophage count was higher in patients with STEMI and non-STEMI than in those with stable angina pectoris. Red thrombus was frequently observed in STEMI compared with others. Local MMP-9 levels were significantly higher than systemic levels (systemic, 42.0 [27.9-73.2] ng/mL versus prestent local, 69.1 [32.2-152.3] ng/mL versus poststent local, 68.0 [35.6-133.3] ng/mL; P<0.01). Poststent local MMP-9 level was significantly elevated in patients with STEMI (STEMI, 109.9 [54.5-197.8] ng/mL versus non-STEMI: 52.9 [33.0-79.5] ng/mL; stable angina pectoris, 28.3 [14.2-40.0] ng/mL; P<0.01), whereas no difference was observed in the myeloperoxidase level. Poststent local MMP-9 and the presence of red thrombus are the independent determinants for STEMI in multivariate analysis.



Local MMP-9 level could determine the early clinical presentation in patients with MI. Local inflammatory activity for atherosclerosis needs increased attention.
From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan.
Tsuyoshi
T
Nishiguchi
From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan. a-tanaka@wakayama-med.ac.jp.
Atsushi
A
Tanaka
From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan.
Akira
A
Taruya
From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan.
Hiroki
H
Emori
From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan.
Yuichi
Y
Ozaki
From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan.
Makoto
M
Orii
From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan.
Yasutsugu
Y
Shiono
From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan.
Kunihiro
K
Shimamura
From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan.
Takeyoshi
T
Kameyama
From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan.
Takashi
T
Yamano
From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan.
Tomoyuki
T
Yamaguchi
From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan.
Yoshiki
Y
Matsuo
From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan.
Yasushi
Y
Ino
From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan.
Takashi
T
Kubo
From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan.
Takeshi
T
Hozumi
From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan.
Yasushi
Y
Hayashi
From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan.
Takashi
T
Akasaka
D060050:Angina, Stable / Q000097:blood / Q000000981:diagnostic imaging / Q000201:enzymology* / Q000628:therapy; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000097:blood / Q000000981:diagnostic imaging / Q000201:enzymology* / Q000628:therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D020780:Matrix Metalloproteinase 9 / Q000097:blood*; D015999:Multivariate Analysis; D000072658:Non-ST Elevated Myocardial Infarction / Q000097:blood / Q000000981:diagnostic imaging / Q000201:enzymology* / Q000628:therapy; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation; D009195:Peroxidase / Q000097:blood; D058226:Plaque, Atherosclerotic; D011446:Prospective Studies; D012307:Risk Factors; D012422:Rupture, Spontaneous; D000072657:ST Elevation Myocardial Infarction / Q000097:blood / Q000000981:diagnostic imaging / Q000201:enzymology* / Q000628:therapy; D012720:Severity of Illness Index; D015607:Stents; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D015854:Up-Regulation
D015415:Biomarkers; D009195:Peroxidase; C579270:MMP9 protein, human; D020780:Matrix Metalloproteinase 9
ST-segment-elevation myocardial infarction; atherosclerosis; matrix metalloproteinase 9; non-ST-segment-elevation myocardial infarction; optical coherence tomography