Antiphospholipid antibodies in patients with myocardial infarction with and without obstructive coronary arteries

Elisabet Svenungsson, Jonas Spaak, Karin Strandberg, Håkan N. Wallén, Stefan Agewall, Elin B. Brolin, Olov Collste, Maria Daniel, Christina Ekenbäck, Mats Frick, Loghman Henareh, Karin Malmqvist, Kerstin Elvin, Peder Sörensson, Shams Y-Hassan, Claes Hofman-Bang, Per Tornvall

Research output: Contribution to journalArticlepeer-review


Background: Recent studies demonstrate that prothrombotic antiphospholipid antibodies (aPL) are overrepresented in patients with myocardial infarction (MI) due to coronary artery disease (MICAD). However, it is not known whether aPL differ between the two subsets of MI: MICAD and MI with nonobstructive coronary arteries (MINOCA). Objectives: To determine whether aPL are associated with MINOCA or MICAD, or with hypercoagulability as assessed by activated protein C–protein C inhibitor (APC–PCI) complex. Methods: Well-characterized patients with MINOCA (n = 98), age- and gender-matched patients with MICAD (n = 99), and healthy controls (n = 100) were included in a cross-sectional case–control study. Autoantibodies (IgA/G/M) targeting cardiolipin and β2glycoprotein-I and specific nuclear antigens were analyzed by multiplexed bead technology. The concentration of APC–PCI was determined as a measure of hypercoagulability by an immunofluorometric sandwich assay. Results: Both prevalence and titers of aPL of the IgG isotype (anti-cardiolipin and/or anti-β2glycoprotein-I) were higher in patients with MINOCA and MICAD than in controls. aPL IgG positivity was twice as frequent among patients with MICAD than MINOCA (11% vs. 6%, nonsignificant). We observed no group differences regarding aPL IgA/M or antibodies targeting specific nuclear antigens. Levels of APC–PCI were elevated in aPL IgG-positive compared to aPL IgG-negative MICAD patients. Conclusions: aPL IgG, but not IgA/M, are enriched particularly in patients with MICAD but also in patients with MINOCA, as compared to controls. Interestingly, signs of hypercoagulability—measured by increased levels of the APC–PCI complex—were present in aPL IgG-positive MICAD patients, indicating an association with functional disturbances of the coagulation system.

Original languageEnglish
Pages (from-to)327-337
JournalJournal of Internal Medicine
Issue number3
Early online date2021
Publication statusPublished - 2022

Subject classification (UKÄ)

  • Rheumatology and Autoimmunity


  • antiphospholipid antibodies
  • arteriosclerosis
  • cardiovascular risk factors
  • coagulation
  • immunology
  • myocardial infarction


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