Enhanced inflammatory response to coronary angioplasty in patients with severe unstable angina.
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).


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.
Liuzzo
G
G
Istituto di Cardiologia, Universitá Cattolica, Roma, Italy.
Buffon
A
A
Biasucci
L M
LM
Gallimore
J R
JR
Caligiuri
G
G
Vitelli
A
A
Altamura
S
S
Ciliberto
G
G
Rebuzzi
A G
AG
Crea
F
F
Pepys
M B
MB
Maseri
A
A
D000209:Acute-Phase Proteins / Q000032:analysis; D000210:Acute-Phase Reaction / Q000209:etiology*; D000368:Aged; D000787:Angina Pectoris / Q000097:blood; D000789:Angina, Unstable / Q000097:blood* / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D002097:C-Reactive Protein / Q000032:analysis; D017023:Coronary Angiography / Q000009:adverse effects; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000685:Serum Amyloid A Protein / Q000032:analysis
D000209:Acute-Phase Proteins; D015850:Interleukin-6; D000685:Serum Amyloid A Protein; D002097:C-Reactive Protein