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Cardiovascular Research 2007 75(4):813-820; doi:10.1016/j.cardiores.2007.05.003
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Copyright © 2007, European Society of Cardiology

Matrix metalloproteinase-3 and coronary remodelling: Implications for unstable coronary disease

Anthony J. White, Stephen J. Duffy, Anthony S. Walton, Jer Fuu Ng, Gregory E. Rice, Swati Mukherjee, James A. Shaw, Garry L. Jennings, Anthony M. Dart and Bronwyn A. Kingwell*

Baker Heart Research Institute and The Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia

* Corresponding author. Baker Heart Research Institute, PO Box 6492, St Kilda Road Central, Melbourne, Victoria, 8008, Australia. Tel.: +61 3 8532 1518; fax: +61 3 8532 1160. bronwyn.kingwell{at}baker.edu.au

Objectives Matrix metalloproteinases (MMPs) are plausible candidates for prediction of unstable coronary syndromes. We hypothesised that the MMP-3 polymorphism (– 1171, 5A/6A) would relate to coronary plaque characteristics and unstable clinical presentation.

Methods and results Forty patients with de novo presentation of coronary artery disease (CAD) were classified into unstable coronary syndrome (n=19) or stable angina pectoris (n=21). On coronary intravascular ultrasound, patients with unstable disease had a greater plaque burden, more positive (outward) coronary remodelling, and all but one were MMP-3 6A allele carriers (p=0.027 compared with stable). The relationship between the 6A allele and unstable presentation was substantiated in a validation cohort of 161 CAD patients (58 stable and 103 unstable) and in the total population of 201 CAD patients (79 stable and 122 unstable, p=0.007), and was independent of conventional risk factors. Furthermore, 6A allele carriers had a higher plasma MMP-3 concentration (15.8±12.5 versus 11.7±7.2 ng/mL, p=0.01), maximum coronary stenosis on angiography (89±15% versus 80±23%, p=0.02), plaque area (12.0±5.2 versus 7.5±3.6 mm2, p=0.03), percentage plaque burden (82±7 versus 71±13%, p=0.003), and remodelling ratio (1.03±0.23 versus 0.83±0.12, p=0.003).

Conclusions The MMP-3 6A allele promotes positive coronary remodelling, greater plaque burden, and increased susceptibility to unstable coronary syndromes in humans.

KEYWORDS Matrix metalloproteinase; Acute coronary syndrome; Vulnerable plaque; Arterial remodelling

Abbreviations: EEL, External elastic lamina • IVUS, Intravascular ultrasound • LSD, Least significant difference • MMPs, Matrix metalloproteinases • PCR, Polymerase chain reaction • RR, Remodelling ratio • SNP, Single nucleotide polymorphism


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