Sustained elevation of serum CD40 ligand levels one month after coronary angioplasty predicts angiographic restenosis.
BACKGROUND
Percutaneous coronary intervention induces an early inflammatory reaction. The intensity of such a reaction as measured by high-sensitivity C-reactive protein has been correlated with recurrent ischemic events, but its association with restenosis remains uncertain.


OBJECTIVE
To characterize the type and duration of the postangioplasty inflammatory reaction and to identify new inflammatory markers correlating with restenosis.


METHODS
Fifty-three consecutive patients who underwent successful balloon angioplasty were studied. Levels of specific inflammatory markers were measured before intervention, and at one-month and six-month follow-up. Six-month clinical and angiographic follow-up was conducted in all patients, and quantitative coronary analysis was systematically performed.


RESULTS
Levels of soluble CD40 ligand (sCD40L) and matrix metalloproteinase-2 showed a rise and fall pattern over six months, with peak levels measured at one month (P < 0.0001), while levels of soluble vascular cell adhesion molecule-1 increased after angioplasty and remained elevated at six months (P = 0.07). Plasma levels of sCD40L at one month correlated with angiographic late loss (r = 0.48, P = 0.001) and were predictive of six-month restenosis (area under receiver operating characteristic curve 0.75 [95% CI 0.61 to 0.88]).


CONCLUSIONS
The results imply that inflammation persists for at least one month following angioplasty and that future therapeutic interventions targeting inflammation to prevent restenosis should be active during this period. Furthermore, the ability of sCD40L levels to predict restenosis at six months may indicate the relevance of this pathway as a therapeutic target for restenosis prevention.
L'Allier
Philippe L
PL
Department of Medicine, Montreal Heart Institute, Montreal, Canada.
Tardif
Jean-Claude
JC
Grégoire
Jean
J
Joyal
Michel
M
Lespérance
Jacques
J
Fortier
Annik
A
Guertin
Marie-Claude
MC
D000800:Angioplasty, Balloon; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D023201:CD40 Ligand / Q000097:blood*; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000097:blood* / Q000000981:diagnostic imaging; D023921:Coronary Stenosis / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D020778:Matrix Metalloproteinase 2 / Q000097:blood; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D016032:Randomized Controlled Trials as Topic; D012680:Sensitivity and Specificity; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood
D015415:Biomarkers; D019010:Vascular Cell Adhesion Molecule-1; D023201:CD40 Ligand; D002097:C-Reactive Protein; D020778:Matrix Metalloproteinase 2