Platelet-derived chemokine RANTES may be a sign of restenosis after percutaneous coronary intervention in patients with stable angina pectoris

Inflammation plays a pathogenic role in the development of restenosis after percutaneous coronary intervention (PCI). We measured and compared the ratio of elevated levels of regulated on activation normally T-cell expressed and secreted (RANTES), monocytic chemotactic peptide-1 (MCP-1), soluble (s) P-selectin and sL-selectin after PCI. Plasma levels of chemokines and soluble markers were measured before, 1, 3 and 7 days after PCI in 52 patients (43 males and nine females, aged 63 +/- 10 years) who underwent PCI and who had repeated angiograms at a 6-month follow-up. Restenosis occurred in 16 (31%) patients. A significant and time-dependent increase in sL-selectin was observed in the restenosis group. However, there were no significant differences in MCP-1 levels with or without restenosis. sP-selectin levels in the restenosis group exhibited a transient elevation at 3 days after PCI. RANTES levels were no different at baseline between patients with or without restenosis. However, a significant and time-dependent decrease in RANTES levels were observed in the non-restenosis group, and patients with restenosis compared with patients without restenosis had a statistically significant ratio of elevated levels of RANTES. These findings suggest that restenosis development after PCI in patients with effort angina pectoris may involve leukocyte activation at an early period after PCI. In addition, platelet-derived chemokine RANTES may be a sign of restenosis after PCI in patients with stable angina pectoris.     

Soluble TRAIL prevents RANTES-dependent restenosis after percutaneous coronary intervention in patients with coronary artery disease

Some factors play pathogenic roles in the development of restenosis after percutaneous coronary intervention (PCI). We measured and compared the ratio of elevated levels of regulated on activation normally T-cell expressed and secreted (RANTES), soluble (s) P-selectin, sE-selectin, s vascular cell adhesion molecule (VCAM)-1, s interleukin-2 receptor (IL-2R) and s tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) after PCI. Plasma levels of chemokines and soluble markers were measured before and 30 days after PCI in 85 patients (61 males and 24 females, aged 61 ± 7 years) who underwent PCI and who had repeated angiograms at a 6-month follow-up. Restenosis occurred in 29 (34.1%) patients. The significant and time-dependent increases in RANTES, sIL-2R and sVCAM-1 were observed in the restenosis group. However, there were no significant differences in sP-selectin and sE-selectin levels with or without restenosis. sTRAIL levels in patients with coronary artery disease were significantly higher than levels in normal controls. Furthermore, unlike the restenosis group, sTRAIL levels after PCI were significantly increased in the non-restenosis group, and sTRAIL levels correlated significantly with sVCAM-1 and sE-selectin. These findings suggest that restenosis development after PCI in patients with coronary artery disease involve the participation of RANTES and activated T-lymphocyte expressing CD25 after PCI, and sTRAIL may prevent this RANTES-dependent restenosis.     

冠状动脉介入治疗对冠心病血浆单核细胞趋化因子-1和白细胞介素-6水平的影响(英文)

目的:通过测定冠心病病人行冠脉介入治疗(PCI)前后血浆单核细胞趋化因子-1(MCP-1)及白细胞介素-6水平(IL-6),探讨PCI对冠心病人炎症指标及术后再狭窄的影响。方法:连续入选经PCI治疗的单支病变冠心病人60例(PCI组),30例冠脉造影证实为冠脉正常的正常对照组。采用酶联免疫吸附法检测PCI组治疗前后,正常对照组冠脉造影前后血浆MCP-1和IL-6水平。结果:与术前比较,PCI组病人术后血浆MCP-1[(17.38±4.58)pg/L比(20.51±4.61)pg/L]、IL-6[(14.59±4.62)pg/mL比(18.87±4.92)pg/mL]水平显著升高(P均<0.01),而正常对照组冠状动脉造影术前后MCP-1、IL-6水平无明显差异(P>0.05)。PCI组病人术后血浆MCP-1和IL-6水平显著高于正常对照组冠脉造影后(P<0.05).结论:冠脉介入治疗后冠心病人的血浆单核细胞趋化因子-1(在炎症反应中起核心调控作用)及白细胞介素-6(炎症反应的中枢性调节因子)水平升高,提示二者与冠脉介入治疗后支架内再狭窄有关。     

Significance of microparticles in progressive systemic sclerosis with interstitial pneumonia

We measured and compared the levels of microparticles, chemokines, cell adhesion molecules and platelet activation markers with a view to developing a better understanding of their potential contributions to the pathophysiology of progressive systemic sclerosis (PSS, scleroderma). The concentrations of all the factors in PSS patients were significantly higher than those in normal subjects. PSS patients were divided to two groups by whether they have interstitial pneumonia (IP) or not. There were no differences in the levels of soluble(s) VCAM-1, sICAM-1, sE-selectin and IL-8 between the two groups. However, there were significant between-group differences in the levels of sP-selectin, sCD40L, ENA-78, RANTES (regulated on activation normally T-cell expressed and secreted), platelet-derived microparticles (PDMPs), monocyte-derived microparticle (MDMPs) and KL-6. The level of tissue factor expression on monocytes by A23187 stimulation in PSS patients was found to be similar to that in healthy controls. Although PDMP did not induce the expression of tissue factor on monocytic cell line (THP-1) directly, the recombinant sCD40 ligand-induced expression of tissue factor on THP-1 and generation of MDMP from this cell line were enhanced by the addition of PDMPs. Our findings suggested that elevated levels of PDMPs and MDMPs may be interpreted as a sign of vascular complications in PSS patients, particularly those complicated with IP, offering a new treatment strategy in these patients.     

Significance of microparticles in progressive systemic sclerosis with interstitial pneumonia

We measured and compared the levels of microparticles, chemokines, cell adhesion molecules and platelet activation markers with a view to developing a better understanding of their potential contributions to the pathophysiology of progressive systemic sclerosis (PSS, scleroderma). The concentrations of all the factors in PSS patients were significantly higher than those in normal subjects. PSS patients were divided to two groups by whether they have interstitial pneumonia (IP) or not. There were no differences in the levels of soluble(s) VCAM-1, sICAM-1, sE-selectin and IL-8 between the two groups. However, there were significant between-group differences in the levels of sP-selectin, sCD40L, ENA-78, RANTES (regulated on activation normally T-cell expressed and secreted), platelet-derived microparticles (PDMPs), monocyte-derived microparticle (MDMPs) and KL-6. The level of tissue factor expression on monocytes by A23187 stimulation in PSS patients was found to be similar to that in healthy controls. Although PDMP did not induce the expression of tissue factor on monocytic cell line (THP-1) directly, the recombinant sCD40 ligand-induced expression of tissue factor on THP-1 and generation of MDMP from this cell line were enhanced by the addition of PDMPs. Our findings suggested that elevated levels of PDMPs and MDMPs may be interpreted as a sign of vascular complications in PSS patients, particularly those complicated with IP, offering a new treatment strategy in these patients.     

Elevated circulating levels of monocyte chemoattractant protein-1 in patients with restenosis after coronary angioplasty

Inflammation plays a pathogenic role in the development of restenosis after percutaneous transluminal coronary angioplasty (PTCA). Monocyte chemoattractant protein-1 (MCP-1) is a potent chemoattractant of monocytes; however, its role in the pathophysiology of restenosis is still unclear. We set out to investigate the role of MCP-1 in restenosis after PTCA. In addition, we tested the hypothesis that MCP-1 exerts its effect, at least in part, by inducing O(2)(-) generation in circulating monocytes. Plasma levels of MCP-1 were measured before and 1, 5, 15, and 180 days after PTCA in 50 patients (30 males and 20 females, aged 62+/-5 years) who underwent PTCA and who had repeated angiograms at 6-month follow-up. Restenosis occurred in 14 (28%) patients. The MCP-1 level was no different at baseline between patients with or without restenosis. However, after the procedure, restenotic patients, compared with nonrestenotic patients, had statistically significant (P<0.0001) elevated levels of MCP-1. In contrast, plasma levels of other chemokines, such as RANTES and interleukin-8, did not differ between the 2 groups after PTCA. Higher MCP-1 throughout the study was correlated with restenosis. Moreover, increased MCP-1 was significantly correlated with increased monocyte activity, as reflected by enhanced O(2)(-) generation. Finally, multivariate regression analysis showed that the MCP-1 plasma level measured 15 days after PTCA was the only statistically significant independent predictor of restenosis (beta=0.688, P<0.0001). This study suggests that MCP-1 production and macrophage accumulation in the balloon-injured vessel may play a pivotal role in restenosis after PTCA. MCP-1 may induce luminal renarrowing, at least in part, by inducing O(2)(-) release in monocytes. Further understanding of the mechanism(s) by which MCP-1 is produced and acts after arterial injury may provide insight into therapies to limit the progression of atherosclerosis and restenosis after balloon angioplasty.     

Increased expression of monocyte chemoattractant protein-1 in atherectomy specimens from patients with restenosis after percutaneous transluminal coronary angioplasty.

The plasma concentration of monocyte chemoattractant protein-1 (MCP-1) antigen is higher in patients with restenosis after coronary angioplasty than in those who do not restenose. In this study the MCP-1 expression of coronary atherectomy specimens was investigated by immunohistochemistry. Samples were obtained from 12 patients with restenosis and 15 with de novo lesions by directional coronary atherectomy. MCP-1 immunoreactivity was found in all patients in the restenosis group and in 8 of the de novo group. The frequency of macrophage expression was higher in the restenosis group than in de novo group. These results indicate that local expression of MCP-1 may be associated with the mechanisms of vascular remodeling after coronary angioplasty.     

Predictive value of the adipocyte-derived plasma protein adiponectin for restenosis after elective coronary stenting

The purpose of this study was to test the hypothesis that plasma levels of adiponectin can predict angiographic in-stent restenosis after coronary stenting. We prospectively examined adiponectin levels in 127 consecutive patients undergoing elective coronary stenting. Restenosis was defined as more than 50% stenosis at follow-up study by quantitative coronary angiography. There were no significant differences in the clinical characteristics or angiographical findings between the groups with restenosis and no restenosis. The levels of adiponectin did not differ between the restenosis group and the no restenosis group (5.7 +/- 2.8 vs 5.9 +/- 3.6 microg/mL, p = 0.72). The plasma levels of adiponectin were not related with the late loss index after coronary stenting (r = 0.01, p = 0.89). The levels of adiponectin were significantly lower in men than in women (5.5 +/- 3.2 vs 8.8 +/- 3.7 microg/ mL, p < 0.001), and negatively correlated with body mass index (r = -0.21, p = 0.01). We analyzed adiponectin levels in male, female, obese, non-obese, diabetes, and non-diabetes patients, however, there were no significant differences between the restenosis group and no restenosis group. This study has demonstrated that the measurement of adiponectin could not predict angiographic restenosis after elective coronary stenting, whereas the plasma levels of adiponectin were associated with some coronary risk factors in patients with coronary artery disease.     

尿微量白蛋白与冠心病支架植入术后1年再狭窄的相关性

目的:分析尿微量白蛋白（MAU）与冠心病患者行支架植入术后1年支架内再狭窄的相关性。方法: 收集2009年3月~2011年6月我科139例冠心病经皮冠状动脉介入治疗患者,支架植入术前检测患者MAU,术后1年根据患者冠状动脉造影结果分为再狭窄组和未狭窄组。结果: 再狭窄组患者MAU水平［(59±16) mg/L］显著高于未狭窄组患者［(39±15) mg/L］ （P<0.05）;再狭窄组中单支病变［(40±3) mg/L］、两支病变［(55±5) mg/L］和三支病变［(82±11) mg/L］患者MAU水平比较差异有统计学意义（P<0.05）。结论: 冠心病患者支架植入术后1年支架内再狭窄与患者支架术前的MAU水平相关,MAU是支架术后再狭窄的很好预测指标。     

曲美他嗪对冠心病患者介入治疗术后生长分化因子15的影响

目的观察冠心病患者在经皮冠状动脉介入治疗围手术期使用曲美他嗪对术后生长分化因子15(GDF-15)、单核细胞趋化蛋白1(MCP-1)以及高敏C反应蛋白(hs-CRP)的影响。评估曲美他嗪使用对冠心病患者预后的影响。方法连续入选冠心病患者共96例并分为两组,观察组(56例)入院后即给予曲美他嗪常规治疗(20 mg,每日3次)至少7天,并在介入治疗术前使用负荷剂量的曲美他嗪(60 mg),术前负荷量的抗血小板药物使用同对照组一致,术后至少服用1月以上维持量曲美他嗪,对照组(40例)术前仅使用常规抗血小板药物,术后24 h内抽血测定GDF-15、MCP-1、hs-CRP浓度,并对出院的患者进行门诊及电话随访,分析两组患者净临床不良事件(NACE)以及主要不良心脑血管事件(MACCE)发生率。结果观察组患者术后GDF-15浓度低于对照组(737.24±299.85 ng/L比1175.84±523.52 ng/L,P=0.002)。MCP-1及hs-CRP浓度在两组患者中差异无显著性。患者平均随访时间(30.26±8.80)月,观察组出现NACE事件2例,对照组出现NACE事件7例,生存分析结果提示观察组NACE事件发生率低于对照组,差异有统计学意义(P=0.012)。结论使用曲美他嗪的冠心病患者介入术后GDF-15浓度较低,NACE事件发生率降低。     

阿托伐他汀对冠心病患者血中趋化因子水平的影响

目的观察冠心病患者血浆中趋化因子的变化,并进一步探讨阿托伐汀对趋化因子的影响。方法健康对照组25例,血脂正常的冠心病70例,随机将冠心病患者分为常规治疗组和阿托伐汀组,检测血浆中单核细胞趋化蛋白-1(monocyte chemoattract protein-1,MCP-1)、T细胞表达和分泌活化蛋白(regulated upon activation normal T cell expressed and secreted,RANTES)及白介素-8(interleukin-8,IL-8)水平。结果与健康对照组相比,冠心病患者血浆中MCP-1、RANTES、IL-8水平明显升高(P<0.01)。常规治疗组和阿托伐汀组治疗4周后MCP-1、RANTES、IL-8水平均有下降(P<0.05,P<0.01),阿托伐汀治疗组较常规治疗组降趋化因子的作用更明显(P<0.05)。结论阿托伐汀降低冠心病患者血浆中趋化因子水平,可能起到稳定粥样斑块的作用。     

The value of serum levels of aldosterone in predicting in-stent restenosis after coronary stent implantation

In recent years,Percutaneous coronary intervention(PCI) as an effective treatment for coronary heart disease has been widely carried out in China.However,people is still confronted with the problem that the incidence of in-stent restenosis (ISR) after PCI.Some risk factors of coronary heart disease have been obviously known,but the in-dependent predictor factors for the ISR has not been clear.Clarifying risk factors for ISR to establish interfering meas-ures may be a new direction for PCI treatment in the future.At present,it has been reported that aldosterone (ALD) may be involved in ISR.In order to further investigate the relationship between the serum ALD levels and ISR,our re-search was to determine the ALD and other serum markers to explore the impact factors of ISR.Methods We meas-ured serum ALD,high sensitivity C-reactive protein (hs-CRP) ,adiponectin (ADP) and other indicators in 258 pa-tients with coronary stenting,and made routine follow-up for 6-9 months to perform coronary angiography.According to the results of coronary angiography,all patients were divided into restenosis group and non-restenosis group.We an-alyzed the relationship between ALD,other indicators and ISR to explore whether serum ALD was an independent risk factor ISR.Results Serum ALD levels were significantly higher in restenosis group than non-restenosis group.Logis-tic regression analysis showed that diabetes,ALD,hs-CRP and complex lesions were also independent risk factors for ISR (P 0.05) ,while the ADP was as a protective factor for ISR (P 0.05) .Conclusions ALD is one of inde-pendent risk factors for ISR after undergoing coronary stent implantation in patients.It has the possibility of becoming one new method in this medical field.     

Adiponectin and sE-selectin concentrations in relation to inflammation in obese type 2 diabetic patients with coronary heart disease

Adipose tissue can release proinflammatory mediators, namely C-reactive protein (CRP), interleukin 1β (IL-1β), and monocyte chemotactic protein 1 (MCP-1), contributing to vascular injury and insulin resistance (IR). Other mediators namely, adiponectin and nitric oxide (NO) are protective. We enrolled type 2 diabetes mellitus (T2DM) obese male patients without coronary heart disease ([CHD] group II, n = 25) and T2DM obese patients with CHD (group III, n = 25). They were compared with 20 age- and body mass index (BMI)-matched nondiabetic control males (group I). Fasting blood glucose (FBG), glycated hemoglobin (HbA(1c)%), lipids, insulin, malondialdehyde ([MDA]; lipid peroxidation product), NO, high-sensitivity CRP (hsCRP), IL-1β, MCP-1, adiponectin as well as sE-selectin concentration were significantly different in patients with T2DM and CHD compared with patients without CHD and nondiabetic controls (P = .01). There was a significant negative correlation between adiponectin and E-selectin (P = .0001). Adipose tissue in T2DM obese patients may contribute to the pathogenesis of CHD.     

单核细胞趋化蛋白-1基因多态性与冠状动脉介入治疗后再狭窄的相关性研究

目的 探讨单核细胞趋化蛋白-1(MCP-1)启动子区-2518A/G基因多态性与冠状动脉(冠脉)粥样硬化病变进程及经皮冠脉腔内成形术(PCI)后再狭窄的相关性.方法 对276例接受PCI并进行冠脉造影随访的患者,采用PCR-RFLP方法进行MCP-1 -2518A/G多态性检测;按冠脉造影结果分为再狭窄组(113例)和无再狭窄组(163例),判定冠脉血管病变及再狭窄与MCP-1 -2518A/G多态性的相关性.结果 MCP-1 -2518A/G基因型频率为:AA纯合子21.0%,GG纯合子34.1%,AG杂合子44.9%,3种基因型血管病变支数和血管平均狭窄程度,差异均无统计学意义(P＞0.05).再狭窄组中AA、AG和GG基因型频率分别为23.9%、40.7%和35.4%,无再狭窄组分别为19.0%、47.9%和33.1%,差异无统计学意义(P=0.446).再狭窄组中-2518A和G等位基因频率分别为44.2%和55.8%,无再狭窄组分别为42.9%和57.1%,差异无统计学意义(P=0.761).结论 冠脉粥样硬化进程及PCI术后再狭窄可能与MCP-1 -2518A/G基因多态性无相关性.     

Soluble receptors for advanced glycation end products (sRAGE) as a predictor of restenosis following percutaneous coronary intervention

Background:

Interaction of advanced glycation end products (AGEs) with their receptor (RAGE) increases expression of inflammatory mediators (tumor necrosis factor alpha [TNF‐α] and soluble vascular cell adhesion molecule‐1 [sVCAM‐1]) and induces oxygen radicals that are implicated in atherosclerosis. Balloon‐injury‐induced atherosclerosis is associated with increased expression of AGEs and RAGE. The soluble receptor for AGE (sRAGE), which acts as a decoy for RAGE ligands (AGEs), prevents atherosclerosis in this model.

Hypothesis:

We evaluated: 1) whether post‐percutaneous coronary intervention (PCI) restenosis is associated with low pre‐PCI serum sRAGE, high serum AGEs, TNF‐α, and sVCAM‐1, and high AGE/sRAGE ratio; 2) whether pre‐PCI and post‐PCI levels of these markers are similar in patients with or without restenosis; and 3) whether sRAGE and AGE/sRAGE ratio have predictive value for post‐PCI restenosis.

Methods:

Angiography was performed in 46 patients with non–ST‐segment elevation myocardial infarction for assessment of restenosis. Serum sRAGE, AGEs, TNF‐α, and sVCAM‐1 were measured in these patients and 20 control subjects.

Results:

Nineteen of the 46 patients developed post‐PCI restenosis, which was associated with lower sRAGE and higher TNF‐α and sVCAM‐1 levels, and higher AGE/sRAGE ratio compared with patients without restenosis. Pre‐PCI and post‐PCI levels of these biomarkers were similar in both groups, except in patients with restenosis, in whom the post‐PCI level of sRAGE was lower and TNF‐α was higher than the pre‐PCI levels. The sensitivity and negative predictive value of sRAGE were 100%, and were higher than those of AGE/sRAGE ratio in identifying post‐PCI restenosis.

Conclusions:

Both low serum sRAGE levels and high AGE/sRAGE ratio have predictive value for post‐PCI restenosis. Copyright © 2008 Wiley Periodicals, Inc. This research was supported by grants from the Heart and Stroke Foundation of Saskatchewan and the Pollack Research Foundation, Saskatoon, Saskatchewan. The authors have no other funding, financial relationships, or conflicts of interest to disclose.     

The correlation between the level of Lp-PLA2 and coronary instent restenosis after PCI

Background Coronary in-stent restenosis(ISR) is an important complication of percutaneous coronary intervention(PCI). However, the relationship between lipoprotein associated phospholipase A2(Lp-PLA2) level and coronary ISR after PCI is rarely reported. Methods 30 patients with coronary ISR after PCI were recruited as the experimental group, 63 patients without coronary ISR after PCI were served as the control group. Lp-PLA2, hypersensitive C-reactive protein(Hs-CRP) and Low density lipoprotein cholesterol(LDL-C) were measured respectively. Smoking, hypertension, diabetes mellitus and other related factors were recorded. The relationships between these factors and restenosis of coronary stent after PCI were analyzed. Results The correlation analysis showed statistically significant(P0.05) between the level of Lp-PLA2, Hs-CRP and the restenosis of coronary stent after PCI, and that Lp-PLA2 level was an independent risk factor for coronary ISR after PCI. The correlation of Lp-PLA2 to ISR was superior to that of Hs-CRP to ISR. Conclusion The increased level of Lp-PLA2 is correlated to coronary ISR after PCI. Therefore, plasma level of Lp-PLA2 may be used as a clinically useful marker for coronary ISR prediction in patients undergoing PCI.     

替米沙坦对冠状动脉介入术后糖尿病炎症因子的影响

目的观察替米沙坦对冠状动脉介入术后急性冠状动脉综合征合并糖尿病患者血炎症因子的影响。方法急性冠状动脉综合征合并糖尿病100例，在成功接受冠状动脉介入术后，随机分为替米沙坦组和常规药物组，随访6个月，用酶联免疫吸附法测定血高敏c反应蛋白、单核细胞趋化蛋白-1水平。术后6个月重复冠状动脉造影，比较两组间的晚期管腔丢失、支架再狭窄率及术后心血管不良事件发生率。结果治疗6个月时，两组的高敏c反应蛋白和单核细胞趋化蛋白～1均降低，而替米沙坦组下降更明硅（P〈0．05）。冠状动脉造影复查86例．两组支架再狭窄率差异无统计学意义，但替米沙坦组晚期管腔丢失及术后心血管不良事件发生率小于对照组。结论替米沙坦可降低冠状动脉介入术后急性冠状动脉综合征合并糖尿病患者血浆高敏C反应蛋白和单核细胞趋化蛋白-1，并可减少其介入术后晚期管腔的丢失及心血管不良事件发生率。     

C-reactive protein plasma levels but not factor VII activity predict clinical outcome in patients undergoing elective coronary intervention

BACKGROUND: Both vascular inflammation as determined by C-reactive protein (CRP) and extrinsic coagulation as measured by factor VII activity (F VII) may predict clinical restenosis rate in patients with stable angina pectoris undergoing elective percutaneous coronary intervention (PCI). HYPOTHESIS: The primary objective of this study was to investigate the associations between baseline CRP levels, F VII activity, and restenosis rate after elective PCI in a 6-month follow-up period. METHODS: This prospective study included 81 patients aged > or = 19 years undergoing PCI for angiographically significant (> or = 70%) stenosis, with or without stenting, and 49 controls. Factor VII activity and CRP were measured in samples collected at angiography and 16-24 h post procedure after overnight fast. Successful PCI was defined as final diameter of < 50% with TIMI 3 flow and no complication within 1 h. After 6 months all patients who had undergone PCI were evaluated via a standardized questionnaire. Clinical restenosis was defined as the occurrence of a major adverse coronary events (MACE), within the follow-up period. RESULTS: Diagnostic angiography led to a significant increase in CRP levels after 16-20 h in patients with discrete CAD (n = 22) but not in patients without any signs of coronary atherosclerosis (n = 27). During a 6-month follow-up after PCI, 17 of 81 (21%) patients developed MACE. Tertiles of CRP levels independently predicted clinical restenosis, as it developed in 33.3% of patients with the highest CRP levels (0.7-4.8 mg/dl), in 16.6% of patients with second tertile CRP levels (0.23-0.69 mg/dl), and in 7.4% of patients with lowest tertile CRP levels (0.0-0.22 mg/dl). There was a significant difference in the restenosis rate between patients from the first and the third tertiles (p = 0.018). Successful PCI was associated with a significant decrease of mean CRP levels after 6 months, whereas PCI in patients suffering from MACE led to no change in CRP levels. There was no association between factor VII activity and clinical outcome after PCI, and F VII activity did not change over a 6-month period. CONCLUSIONS: In patients with stable angina pectoris undergoing elective PCI, increased preprocedural and 6-month follow-up CRP plasma levels are associated with clinical restenosis. Factor VII plasma activity lacks such correlations.     

Tissue factor expression in coronary circulation as a prognostic factor for late restenosis after coronary angioplasty.

We investigated changes in blood coagulation in the coronary circulation after percutaneous transluminal coronary angioplasty (PTCA) and its clinical significance. We examined 43 patients with ischemic heart disease who underwent elective PTCA of isolated stenotic lesions in the left coronary artery. Ten patients underwent PTCA alone, 15 received percutaneous transluminal rotational atherectomy (PTRA) and 18 stent implantation. Blood samples were drawn from the coronary sinus before and immediately after PTCA, as well as 4 and 24 h later. Plasma levels of tissue factor (TF), thrombin-antithrombin III complex (TAT) and prothrombin fragment 1+2 (F 1+2) were measured by enzyme-linked immunosorbent assay. Follow-up coronary angiography was performed 6 months after PTCA. Minimal luminal diameter was assessed by quantitative coronary angiography to evaluate late loss index. TF, TAT and F 1+2 levels in the coronary sinus blood showed significant increases 24 h after PTCA. A significant positive correlation was found between changes in TF levels 24 h after PTCA and late loss index 6 months after the procedure. TF levels in the coronary sinus blood were significantly higher in patients with late restenosis than in those without restenosis. These results suggest that TF expression in the coronary circulation after PTCA is a prognostic factor for late restenosis.     

Transcardiac release of soluble adhesion molecules during coronary artery bypass grafting: effects of crystalloid and blood cardioplegia

BACKGROUND: Dysfunction of myocardium as a result of ischemia/reperfusion during coronary artery bypass grafting (CABG) is currently one of the biggest problems in cardiovascular surgery. In previous studies, it has been well established that activated leukocytes and coronary vascular endothelial cells play an important role in the development of cardiac tissue damage during ischemia followed by reperfusion. Interactions between both of these cell types require the expression of adhesion molecules on their surface. In certain conditions, on cell activation, the adhesion proteins may be released from activated cells in soluble form into circulation. The purpose of our study was to establish whether the use of blood cardioplegia modifies plasma levels of soluble intracellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble E-selectin (sE-selectin), and soluble L-selectin (sL-selectin) in comparison with crystalloid cardioplegia in patients undergoing CABG. METHODS: Patients undergoing CABG were classified into two groups to receive cold crystalloid cardioplegia (St. Thomas' Hospital) or cold blood cardioplegia (method of Buckberg), followed by a "warm-shot" of the solution. Coronary sinus and arterial blood samples were obtained from 50 patients (42 men and 8 women; age range, 34 to 73 years) before aortic cross-clamping, at the beginning of reperfusion, and after 30 min of reperfusion. Plasma levels of soluble adhesion molecules were measured using sensitive enzyme-linked immunosorbent assays. RESULTS: The transcardiac release of sICAM-1 and sVCAM-1 following myocardial ischemia/reperfusion during CABG was evident in both groups of patients. However, the increase of soluble forms of both of these adhesion proteins was more significant in the group of patients receiving crystalloid cardioplegia. Crystalloid cardioplegia resulted in decreased plasma level of sE-selectin in the coronary sinus blood sample after 30 min of reperfusion. No significant changes in plasma levels of sL-selectin in either group were observed. CONCLUSION: Cardioplegia may affect the release of soluble forms of adhesion molecules from ischemic myocardium and modify endothelium activation in patients undergoing CABG.