Antimyocardial antibodies in patients with coronary heart disease

Clinical and monitored data were collected from 173 patients admitted to a Medical Intensive Care Unit for suspected acute myocardial infarction. Infarction was proven in 117, and 56 had coronary insufficiency. Sera obtained on the first, fifth, and fourteenth days of hospitalization were tested for antimyocardial antibodies by the indirect fluorescent antibody and antiglobulin consumption methods. Fifty of the 117 patients with infarcts and 28 of 56 with coronary insufficiency had antibodies. None was found in 11 of 13 patients with non-coronary heart disease and in 15 normal controls. Antimyocardial antibodies were identified in patients with coronary disease whether they had acute myocardial infarction or not. This finding indicates that myocardial damage often accompanies non-infarctive myocardial ischemia. The detection of antimyocardial antibodies in patients without overt evidence of infarction may, therefore, aid in the diagnosis of coronary insufficiency. While antibodies to components of heart muscle are not specific for coronary disease, other conditions in which they occur are relatively rare and can usually be excluded on clinical grounds. Finally, our studies show that many patients with coronary disease already have antimyocardial antibodies in their serum when they arrive at the hospital. Subclinical myocardial damage may thus precede the onset of symptoms. Periodic tests for antimyocardial antibodies could reveal these prodromal events and indicate the need for therapeutic intervention.