[Urgent percutaneous coronary intervention leads to a decrease in serum concentrations of soluble CD40 ligand].
OBJECTIVE
Inflammation as a consequence of vascular injury after percutaneous coronary intervention (PCI) is a pathological substrate of restenosis and of its complications. The aim of the study was to examine perprocedural inflammatory response expressed by soluble CD40 ligand (sCD40L) and C-reactive protein (CRP) in patients treated with PCI and dual antiplatelet therapy.


METHODS
The experimental group included 52 patients (80.8% men, age 60 +/- 9 years) with angina pectoris treated by PCI (22 urgent PCI) with stent implantation, and dual antiplatelet therapy (tienopiridins and aspirin), according to the current recommendations for the execution of the intervention. The control group consisted of 8 patients (70.5% men, age 59 +/- 7 years) with angina pectoris, who had undergone coronarography taking aspirin 3 days prior to it. In all the patients 24 hours before and after the PCI concentrations of CRP and sCD40L in the blood were determined.


RESULTS
In the experimental group, the concentration of sCD40L was lower as compared to the control (p < 0.02). In 34 (65%) patients postprocedural decrease in sCD40L was recorded, in 18 (34.6%) of them increase, while in 50 (96%) patients there was a rise in CRP. The patients with postprocedural fall in sCD40L hod greater preprocedural concentration of sCD40L (p < 0.001), and less postprocedural concentration of sCD40L (p < 0.001), compared to the group with an increase in sCD40L after the PCI, while CRP levels between these groups were not statistically different. Patients treated with emergency PCI compared to elective patients had a postprocedural decrease in sCD40L (p = 0.02). Increase in the level of CRP was higher in the group with emergency PCI in relation to elective PCI (p < 0.01).


CONCLUSIONS
Emergency PCI procedures in the treatment of patients with unstable angina pectoris lead to a postprocedural fall in the serum concentration of sCD40L. Dual antiplate therapy with tienopiridins and aspirin inhibits the release of sCD40L. Regardless a clinical presentation of coronary disease PCI leads to an postprocedural increase in concentrations of CRP in the serum.
Vojnomedicinska akademija, Klinika za urgentnu internu medicinu, Beograd, Srbija. ratkovic@eunet.rs
Nenad
N
Ratković
Radoslav
R
Romanović
Aleksandra
A
Jovelić
Branko
B
Gligić
Saso
S
Rafajlovski
Danilo
D
Vojvodić
Slobodan
S
Obradović
D000789:Angina, Unstable / Q000097:blood / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D023201:CD40 Ligand / Q000097:blood*; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage
D010975:Platelet Aggregation Inhibitors; D023201:CD40 Ligand