Characterization of circulating endothelial cells in acute myocardial infarction.

Acute myocardial infarction (MI), which involves the rupture of existing atheromatous plaque, remains highly unpredictable despite recent advances in the diagnosis and treatment of coronary artery disease. Accordingly, a clinical measurement that can predict an impending MI is desperately needed. Here, we characterize circulating endothelial cells (CECs) using an automated and clinically feasible CEC three-channel fluorescence microscopy assay in 50 consecutive patients with ST-segment elevation MI and 44 consecutive healthy controls. CEC counts were significantly elevated in MI cases versus controls, with median numbers of 19 and 4 cells/ml, respectively (P = 1.1 × 10(-10)). A receiver-operating characteristic (ROC) curve analysis demonstrated an area under the ROC curve of 0.95, suggesting near-dichotomization of MI cases versus controls. We observed no correlation between CECs and typical markers of myocardial necrosis (ρ = 0.02, creatine kinase-myocardial band; ρ = -0.03, troponin). Morphological analysis of the microscopy images of CECs revealed a 2.5-fold increase (P < 0.0001) in cellular area and a twofold increase (P < 0.0001) in nuclear area of MI CECs versus healthy controls, age-matched CECs, as well as CECs obtained from patients with preexisting peripheral vascular disease. The distribution of CEC images that contained from 2 to 10 nuclei demonstrates that MI patients were the only subject group to contain more than 3 nuclei per image, indicating that multicellular and multinuclear clusters are specific for acute MI. These data indicate that CEC counts may serve as a promising clinical measure for the prediction of atherosclerotic plaque rupture events.

Treatment of ischemic stroke complicating cardiac catheterization with systemic thrombolytic therapy.

Ischemic stroke is a rare but serious complication of cardiac catheterization. We report a case in which systemic thrombolytic therapy was successfully utilized in treating a patient with a cerebellar stroke, leading to obtundation during elective cardiac catheterization. Underlying bilateral vertebrobasilar disease with thrombotic embolization to the basilar artery was postulated to be the pathophysiological basis for the stroke and subsequent success of thrombolytic treatment in this patient. As the consequences of this rare complication are severe, systemic thrombolytic therapy should be considered for patients suffering an acute ischemic stroke during cardiac catheterization or percutaneous coronary intervention.