Immunostaining by complement C9: A tool for early diagnosis of myocardial infarction and application in forensic medicine

Before the first 12 hours, diagnosis of early myocardial infarctions is alw ays difficult for forensic pathologists. We tested complement C9 expression in 121 formalin-fixed and paraffin-embedded heart samples by an immunohist ochemical procedure. The heart specimens were separated into four groups: 3 3 cases in group 1 with typical ischemic damages histologically located, 20 cases in group 2 with death related to myocardial infarction on the basis of ischemic presentation on electrocardiogram but no obvious histological i schemic damage, 35 cases in group 3 with severe coronary disease without ca use of death found at the autopsy. and 33 cases in group 3 without sign of myocardial infarction and without coronary disease. In the first group, all 33 heart samples showed a well-defined C9 expression in the necrotic areas . The second group in 17 of 20 cases showed positive areas for C9 expressio n. In the other three heart specimens, only few stained cells were observed whereas the painful symptoms had begun less than 1 h before death. The thi rd group showed C9 immunopositive areas in six of 35 cases, few stained cel ls in 8 cases, and no C9 deposition in the 21 other cases. The last group s howed no staining area. To avoid nonspecific C9 staining due to tissue auto lysis, we studied C9 expression during a controlled putrefactive process in four cases included in group 1; staining was found only in infarcted myoca rdial areas, and was observed up to ten days. Specificity of C9 expression was evaluated to be 100% [89.4 to 100%] and sensitivity to be 85% [62.11 to 96.79%]. In conclusion, evaluation of immunohistochemical expression of C9 appears to be a highly sensitive and specific marker of early myocardial i nfarction, useful in forensic medicine if survival is more than 1 h after t he beginning of myocyte damage.