Abstract 288: Positive Correlation of Intracoronary C-Reactive Protein With Platelet-Monocyte Complexes and Serum Amyloid A Protein Suggests Local Interrelationship Between Platelet Activation and Inflammation in the Acute Coronary Syndrome Patients.
Introduction: — Formation of platelet monocyte complexes (PMCs) may be a link between platelet activation and inflammation in the pathogenesis of acute coronary syndrome (ACS). It is not clear whether this relationship between PMC formation and inflammation is a systemic or a local phenomenon at the site of coronary plaque rupture.
Hypothesis: — Relationship between PMC expression and inflammation is a local phenomenon in the coronary circulation of the ACS patients.
Methods: — Samples were collected from coronary artery (CO) (distal to the lesion), using microcatheter, aorta (AO) and right atrium (RA) of 23 ACS patients (15 STEMI and 8 NSTEMI) and 7 stable angina patients . Plasma high sensitive C-reactive protein (CRP) and serum amyloid A protein (SAA) were estimated using BNII nephelometric method. PMCs (CD61,CD14 double positive cells) were identified by flow cytometry with FACS calibur machine (BD Biosciences).
Results: — In the ACS group the median (IQR) CRP levels were 2.4 (0.8–5.9) mg/l, 3.0 (0.8–6.8) mg/l and 3.05 (1.07–6.5) mg/l in the CO, AO and RA respectively. In the stable group the corresponding CRP levels; median (IQR) were 0.80 (0.57–1.55) mg/l, 0.80 (0.40–2.3) mg/l , 0.80 (0.70–2.1) mg/l . The SAA values, median (IQR) at the respective sites were 3.7 (1.8–12.7) mg/l, 5.3 (2.6–14.0) mg/l, 5.5 (2.5–13.65) mg/l in the ACS group and 2.4 (1.1–2.7) mg/l, 2.6(1.4–3.0) mg/l, 2.5 (1.6–2.8) mg/l in the stable group.There was no significant site specific difference in the CRP and SAA concentrations in either of these groups . Twelve out of 23 patients in ACS group had intracoronary CRP values ≥ 2.4 mg/l (≥ median).In this subgroup there was significant positive correlation between intracoronary CRP with PMC (r=0.68, p=0.0037) and SAA (r=0.80, p= 0.0014). These correlations were not observed in the peripheral circulation of the ACS patients and in the stable angina patients.
Conclusions: — In conclusion inflammation is a systemic phenomenon in coronary artery disease. Inflammatory burden is higher in the ACS patients both locally inside the coronary artery and systemically compared to the stable angina patients. Positive correlation of intracoronary CRP,PMC and SAA suggests local interrelationship between platelet activation and inflammation in ACS.
- © 2010 by American Heart Association, Inc.