OBJECTIVE Circulating microvesicles (MV) are surrogate biomarkers of atherosclerosis. However, their role in acute coronary syndromes (ACS) has not been fully elucidated yet. We sought to examine the association of circulating apoptotic MVs with ACS pathophysiology. APPROACH AND RESULTS One hundred and fifty-three patients (n = 153) were included in the study; 49 patients with ST-elevation myocardial infarction (STEMI), 35 with non-STEMI (NSTEMI), 38 with unstable angina, 15 with stable coronary artery disease and 16 control individuals. Flow cytometry analysis was used to quantify circulating apoptotic/non-apoptotic (phospatidyloserine+/phospatidyloserine-) endothelial cell (EMV), red blood cell (RMV) and platelet (PMV) derived MV. Flow-mediated dilatation (FMD) of the brachial artery was assessed by ultrasound to estimate endothelial function. The inflammatory profile was assessed by serum C-reactive protein (hsCRP) levels. Apoptotic only (but not non-apoptotic) MV were increased in patients with ACS (EMV, P = 2.32 × 10-9; RMV, P = .0019; PMV, P = .01). Hierarchical clustering of the total population of ACS patients (n = 122) by circulating levels of phospatidyloserine+ EMV, RMV and PMV identified two discreet clusters of patients without any differences in traditional risk factors, but significant differences in brachial FMD (5.2% (2.5) vs. 4.1% (2.3), P < .05) that remained significant after adjustment for co-variates. The prevalence of STEMI, a surrogate for plaque rupture and vessel thrombotic occlusion, was significantly higher in the patient cluster with impaired endothelial function (60% vs 32%, P = .016, adjusted odds ratio for STEMI, 3.041, 95%CI, 1.160 to 7.968, p = .024). CONCLUSION Our findings indicate that the circulating levels of apoptotic MV are increased in ACS patients and their plasma profiles associate with endothelial dysfunction and thrombotic complications in ACS patients.

中文翻译：

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凋亡的微泡的血浆特征与急性冠状动脉综合征中的内皮功能障碍和斑块破裂有关。

目的循环微泡（MV）是动脉粥样硬化的替代生物标志物。但是，它们在急性冠状动脉综合征（ACS）中的作用尚未完全阐明。我们试图检查循环凋亡MV与ACS病理生理学的关系。方法和结果153例患者（n = 153）被纳入研究。49例ST抬高型心肌梗死（STEMI），35例非STEMI（NSTEMI），38例不稳定型心绞痛，15例稳定型冠状动脉疾病和16例对照个体。流式细胞仪分析用于定量循环的凋亡/非凋亡（磷脂酰丝氨酸+ /磷脂酰丝氨酸-）内皮细胞（EMV），红细胞（RMV）和血小板（PMV）衍生的MV。通过超声评估肱动脉的血流介导的扩张（FMD），以评估内皮功能。通过血清C反应蛋白（hsCRP）水平评估炎症状况。ACS患者仅凋亡（而非非凋亡）的MV增加（EMV，P = 2.32×10-9； RMV，P = .0019； PMV，P = .01）。通过循环使用磷脂酰丝氨酸+ EMV，RMV和PMV的水平对ACS患者总数（n = 122）进行分层聚类，确定了两个离散的患者群，传统危险因素无任何差异，但臂部FMD差异显着（5.2％（2.5）） vs. 4.1％（2.3），P <.05），在对协变量进行调整后，该值仍然显着。STEMI（斑块破裂和血管血栓闭塞的替代物）在内皮功能受损的患者组中明显更高（60％vs 32％，P = .016，STEMI调整比值比为3.041，95％CI， 1.160至7.968，p = .024）。