(Circulation. 1998;98:2370-2376.)
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports |
Enhanced Inflammatory Response to Coronary Angioplasty in Patients With Severe Unstable Angina
From the Istituto di Cardiologia, Universitá Cattolica, Roma, Italy (G.L., A.B., L.M.B., G.C., A.G.R., F.C., A.M.); Immunological Medicine Unit, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK (J.R.G., M.B.P.); and Istituto di Ricerche di Biologia Molecolare, P. Angeletti, Pomezia, Italy (A.V., S.A., G.C.).
Correspondence to Giovanna Liuzzo, MD, Istituto di Cardiologia, Universitá Cattolica del Sacro Cuore Largo A. Gemelli, 8-00168 Rome, Italy.
Background—Systemic markers of inflammation have been found in unstable angina. Disruption of culprit coronary stenoses may cause a greater inflammatory response in patients with unstable than those with stable angina. We assessed the time course of C-reactive protein (CRP), serum amyloid A protein (SAA), and interleukin-6 (IL-6) after single-vessel PTCA in 30 patients with stable and 56 patients with unstable angina (protocol A). We also studied 12 patients with stable and 15 with unstable angina after diagnostic coronary angiography (protocol B).
Methods and Results—Peripheral blood samples were taken before and 6, 24, 48, and 72 hours after PTCA or angiography. In protocol A, baseline CRP, SAA, and IL-6 levels were normal in 87% of stable and 29% of unstable patients. After PTCA, CRP, SAA, and IL-6 did not change in stable patients and unstable patients with normal baseline levels but increased in unstable patients with raised baseline levels (all P<0.001). In protocol B, CRP, SAA, and IL-6 did not change in stable angina patients after angiography but increased in unstable angina patients (all P<0.05). Baseline CRP and SAA levels correlated with their peak values after PTCA and angiography (all P<0.001).
Conclusions—Our data suggest that plaque rupture per se is not the main cause of the acute-phase protein increase in unstable angina and that increased baseline levels of acute-phase proteins are a marker of the hyperresponsiveness of the inflammatory system even to small stimuli. Thus, an enhanced inflammatory response to nonspecific stimuli may be involved in the pathogenesis of unstable angina.
Key Words: angina • angioplasty • plaque • interleukins
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|
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|
|
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|
|
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|
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|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
D. P. Chew, D. L. Bhatt, M. A. Robbins, M. S. Penn, J. P. Schneider, M. S. Lauer, E. J. Topol, and S. G. Ellis Incremental Prognostic Value of Elevated Baseline C-Reactive Protein Among Established Markers of Risk in Percutaneous Coronary Intervention Circulation, August 28, 2001; 104(9): 992 - 997. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
J. Figueras, Y. Monasterio, R. M. Lidon, E. Nieto, and J. Soler-Soler Thrombin formation and fibrinolytic activity in patients with acute myocardial infarction or unstable angina: in-hospital course and relationship with recurrent angina at rest J. Am. Coll. Cardiol., December 1, 2000; 36(7): 2036 - 2043. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Y. H. Lip and A. D. Blann Thrombogenesis and fibrinolysis in acute coronary syndromes: Important facets of a prothrombotic or hypercoagulable state? J. Am. Coll. Cardiol., December 1, 2000; 36(7): 2044 - 2046. [Full Text] [PDF]
|
|
|
|
|
|
L.M. Biasucci C-reactive protein and dangerous liaisons Eur. Heart J., October 1, 2000; 21(19): 1560 - 1562. [PDF]
|
|
|
|
|
|
G. Caligiuri, G. Paulsson, A. Nicoletti, A. Maseri, and G. K. Hansson Evidence for Antigen-Driven T-Cell Response in Unstable Angina Circulation, September 5, 2000; 102(10): 1114 - 1119. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Wijns and F. Ribichini CRP: does it stand for C oronary R estenosis P rediction? Eur. Heart J., July 2, 2000; 21(14): 1121 - 1123. [PDF]
|
|
|
|
|
|
M. Gottsauner-Wolf, G. Zasmeta, S. Hornykewycz, M. Nikfardjam, E. Stepan, P. Wexberg, G. Zorn, D. Glogar, P. Probst, G. Maurer, et al. Plasma levels of C-reactive protein after coronary stent implantation Eur. Heart J., July 2, 2000; 21(14): 1152 - 1158. [Abstract] [PDF]
|
|
|
|
 |
|
 N. A HERITY Interleukin 6: a message from the heart Heart, July 1, 2000; 84(1): 9 - 10. [Full Text]
|
|
|
|
|
|
Y Hojo, U Ikeda, T Katsuki, O Mizuno, H Fukazawa, K Kurosaki, H Fujikawa, and K Shimada Interleukin 6 expression in coronary circulation after coronary angioplasty as a risk factor for restenosis Heart, July 1, 2000; 84(1): 83 - 87. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. SUZUKI, S. ISHIWATA, K. HASEGAWA, K. YAMAMOTO, and T. YAMAZAKI Raised interleukin 6 concentrations as a predictor of postangioplasty restenosis Heart, May 1, 2000; 83(5): 578 - 578. [Full Text]
|
|
|
|
|
|
P. M. Ridker, N. Rifai, M. J. Stampfer, and C. H. Hennekens Plasma Concentration of Interleukin-6 and the Risk of Future Myocardial Infarction Among Apparently Healthy Men Circulation, April 18, 2000; 101(15): 1767 - 1772. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. M. Ridker, C. H. Hennekens, J. E. Buring, and N. Rifai C-Reactive Protein and Other Markers of Inflammation in the Prediction of Cardiovascular Disease in Women N. Engl. J. Med., March 23, 2000; 342(12): 836 - 843. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Liuzzo, L. M. Biasucci, J. R. Gallimore, G. Caligiuri, A. Buffon, A. G. Rebuzzi, M. B. Pepys, and A. Maseri Enhanced inflammatory response in patients with preinfarction unstable angina J. Am. Coll. Cardiol., November 15, 1999; 34(6): 1696 - 1703. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Simon, E. Ory, and T. Bohm Enhanced Inflammatory Response to Coronary Angioplasty in Patients With Severe Unstable Angina Circulation, November 9, 1999; 100 (19): e95 - e95. [Full Text] [PDF]
|
|
|
|
|
|
U. Ikeda, Y. Hojo, T. Katsuki, and K. Shimada Enhanced Inflammatory Response to Coronary Angioplasty in Patients With Severe Unstable Angina Circulation, November 9, 1999; 100 (19): e96 - e96. [Full Text] [PDF]
|
|
|
|
|
|
A. Blum Inflammatory Response in Unstable Angina Circulation, November 9, 1999; 100 (19): e97 - e97. [Full Text] [PDF]
|
|
|
|
|
|
|