Macrophages, smooth muscle cells, and tissue factor in unstable angina - Implications for cell-mediated thrombogenicity in acute coronary syndromes

Background Macrophage expression of tissue factor may be responsible for coronary thrombogenicity in patients with plaque rupture. In patients without plaque rupture, smooth muscle cells may be the thrombogenic substrate. This study was designed to identify the cellular correlations of tissue factor in patients with unstable angina. Methods and Results Tissue from 50 coronary specimens (1560 pieces) from patients with unstable angina and 15 specimens from patients with stable angina were analyzed. Total and segmental areas (in square millimeters) were identified with trichrome staining. Macrophages, smooth muscle cells, and tissue factor were identified by immunostaining. Tissue factor content was larger in unstable angina (42+/-3%) than in stable angina (18+/-4) (P=.0001). Macrophage content was also larger in unstable angina (16+/-2%) than in stable angina (5+/-2%) (P=.002). The percentage of tissue factor located in cellular areas was larger in coronary samples from patients with unstable angina (67+/-8%) than in samples from patients with stable angina (40+/-5%) (P=.00007). Multiple linear stepwise regression analysis showed that coronary tissue factor content correlated significantly (r=.83, P<.0001) with macrophage and smooth muscle cell areas only in tissue from patients with unstable angina, with a strong relationship between tissue factor content and macrophages in the atheromatous gruel (r=.98, P<.0001). Conclusions Tissue factor content is increased in unstable angina and correlates with areas of macrophages and smooth muscle cells, suggesting a cell-mediated thrombogenicity in patients with acute coronary syndromes.