髓过氧物酶在冠状动脉粥样硬化性心脏病诊断和预后中的意义

目的评估血清髓过氧化物酶(myeloperoxidase,MPO)浓度在冠状动脉粥样硬化性心脏病(冠心病)进展过程中作为诊断和预后标志物的可行性。方法采用酶联免疫分析法测定血清MPO、心肌肌钙蛋白,肌酸激酶(CK-MB),C反应蛋白,纤维蛋白原和D二聚体浓度,并对它们的诊断敏感性进行比较。结果血清MPO浓度随着冠心病进展而增加,作为的诊断和预后标志物,其敏感性要高于心肌肌钙蛋白I,肌酸激酶,C反应蛋白,纤维蛋白原和D二聚体。结论MPO在冠心病进展过程中对不稳定动脉粥样硬化的风险评估时,可以充当诊断和预后的标志物。     

髓过氧化物酶及其基因多态性与冠心病的关系

目的:探讨髓过氧化物酶(MPO)与冠心病(CHD)的关系,预测CHD发生的危险度。方法:采用病例-对照研究方法。选择住院CHD患者219例,其中稳定型心绞痛(SAP)组74例,不稳定型心绞痛(UAP)组97例,急性心肌梗死(AMI)组48例;对照组70例,根据临床症状、心肌标志物等理化指标检查及冠状动脉造影结果确诊。用酶联免疫测定法检测各组血浆MPO的含量。用聚合酶链-限制性片段长度多态性(PCR-RFLP)和基因测序法判定各研究对象的基因型。结果:急性冠状动脉综合征(ACS)组MPO浓度明显高于SAP组和对照组(P<0.01),SAP组与对照组之间差异无统计学意义(P>0.05);MPO在单支、双支、3支病变组中均高于对照组(P<0.05);MPO在1-20分、21-40分、大于40分组中均高于对照组(P<0.05);携带GA型基因的CHD的发病率是携带AA型基因的3.10倍;携带型GG基因的CHD发病率是携带AA型基因的2.70倍。结论:MPO冠状动脉粥样硬化斑块不稳定的标志,与CHD的发生有关。MPO-463G/A多态性与CHD的易患性显著相关。     

髓过氧化物酶与急性冠状动脉综合征的相关性研究

目的探讨冠状动脉内粥样硬化斑块不同稳定程度患者的血清髓过氧化物酶(myeloperoxidase,MPO)水平的变化。方法检测23例ST段抬高的急性冠状动脉综合征(STEACS组)患者、27例非ST段抬高的急性冠状动脉综合征(NSTEACS组)患者4、8例稳定性心绞痛(SAP组)患者以及55例对照组患者的血清MPO、肌钙蛋白T(cTnT)、高敏C反应蛋白(hs-CRP)等主要指标的水平,同时通过冠状动脉造影进行对比研究。结果ACS患者血清MPO水平明显高于SAP组和对照组,尤以STEACS组增高更显著,并随着血清MPO的增高,发生ACS的风险越大,血清MPO水平最高四分位组发生ACS的OR是最低四分位组的4.6倍(95%CI:1.6~13.4),而且比hs-CRP和绝对中性粒细胞数(ANC)预测发生ACS的风险更强;冠状动脉不同狭窄程度各组之间血清MPO水平的差异有统计学意义;cTnT<0.1μg/L患者占74.7%,且其中血清MPO水平最高四分位组发生ACS是最低四分位组的4.9倍;MPO与hs-CRP、ANC无明显相关关系,是ACS独立的危险因素。结论血清MPO水平与ACS的严重程度显著相关,尤其当cTnT水平较低时,它能早期独立预测ACS的发生。     

急性冠状动脉综合征患者血清脑钠肽浓度的变化及临床意义

目的:探讨急性冠状动脉综合征(ACS)患者血清脑钠肽(BNP)水平与其冠状动脉病变严重程度及心脏功能的关系。方法:ACS患者81例,分为不稳定型心绞痛(UAP组)组39例和急性心肌梗死组(AMI)组42例,于入院后即刻检测血清BNP水平,并检查冠状动脉病变情况和左室射血分数,分析BNP的水平与冠状动脉病变、心脏功能之间的关系。结果:血清BNP水平随着病情的加重而逐渐升高,AMI组明显高于UAP组,并且从单支病变、双支病变到3支病变BNP水平逐渐增高,两者呈正相关(rs=0.813,P<0.01);随着左室射血分数的降低,BNP水平逐渐升高,两者呈负相关(rs=-0.846,P<0.01)。结论:血清BNP水平与冠状动脉病变程度及心功能相关,可用于ACS患者的危险评估。     

Comparison of coronary artery specific leukocyte-platelet conjugate formation in unstable versus stable angina pectoris

This study evaluates transcoronary changes in neutrophil and platelet activation and conjugate formation in patients with angina pectoris secondary to coronary artery disease. We examined parameters of neutrophil and platelet activation as well as the neutrophil-platelet conjugate formation in patients who underwent diagnostic coronary angiography. Thirty-nine patients with chest pain referred for cardiac catheterization were studied (23 patients with unstable angina pectoris [UAP] and 16 with stable angina pectoris [SAP]). Before coronary angiography, blood samples were obtained simultaneously from the aortic root and coronary sinus to assess leukocyte (CD11b) and platelet (CD62P) activation and leukocyte-platelet conjugates. There was a 94% increase in CD62-expressing platelets from the aorta to the coronary sinus in patients with UAP compared with a 49% increase in patients with SAP. The percentage of neutrophil-platelet conjugates increased by 22% in patients with UAP compared with a 16% decrease in those with SAP (p <0.01). In contrast, monocyte-platelet binding across the coronary bed increased to a similar degree in both groups. This study demonstrates an increase in neutrophil-platelet conjugates across the coronary circulation in UAP, compatible with a higher activation state in both cell types.     

Increased C-reactive protein level after coronary stent implantation in patients with stable coronary artery disease

Background Elevation of C-reactive protein (CRP), among other markers of inflammation, is associated with an increased risk for cardiac events in patients with known coronary diseases and in apparently healthy individuals. Moreover, in patients with acute coronary syndromes, elevated serum levels of CRP are strongly predictive of the risk for death from cardiac causes. The purpose of this study was to investigate whether mechanical rupture of an atherosclerotic coronary plaque during elective stent implantation in patients with stable coronary artery disease (CAD) at low risk will cause a significant increase in serum levels of CRP. Methods and Results We measured serum CRP levels in 40 patients. Group 1 consisted of 12 consecutive patients with stable coronary disease who were at low risk, before and after elective coronary stent implantation. We compared the results in these patients to those of patients in 2 control groups: group 2 consisted of 12 consecutive patients with non-ST-segment elevation acute coronary syndrome (NSTSE ACS) who were undergoing coronary stent implantation, and group 3 included 16 consecutive patients with stable or unstable CAD who were undergoing diagnostic coronary angiography only without PCI. Peripheral blood samples for CRP level testing were withdrawn before percutaneous coronary intervention or angiography at the completion of the procedure, and 6, 20, and 48 hours thereafter. All patients with stable CAD (group 1) had a significant and uniform increase in serum CRP levels after elective stent implantation. The low mean baseline serum CRP levels increased 4.9 ± 4.1-fold 20 hours after coronary intervention (2.1 ± 1.2 before, 7.9 ± 3.4 after, P < .002). The baseline CRP level was much higher in the patients with unstable coronary syndromes (group 2). In this group, only a 2.1-fold increase in mean CRP level was observed after stent implantation (7.4 ± 5.5 before, 14.1 ± 9.6 after, P < .004). Also, the response in this group was less uniform when compared with that in the stable CAD group. By contrast, in patients undergoing diagnostic coronary angiography, the mean baseline CRP level was higher than in the patients in the group with stable CAD; however, the mean CRP after the procedure was not significantly elevated in this group (4.5 ± 3.6 before, 5.5 ± 3.7 20 hours after, P = not significant). Conclusions Mechanical disruption of an atherosclerotic coronary plaque during elective coronary stent implantation in patients with stable CAD who are at low risk causes a systemic inflammatory response expressed by marked elevation in CRP concentration. (Am Heart J 2003;145:248-53.)     

Epidemiologic study of use of resources in patients with unstable angina: the EARISA registry. On behalf on the EARISA Investigators (Epidemiologia dell'Assorbimento di Risorse nell'Ischemia, Scompenso e Angina)

AIM: The EARISA Registry was designed to describe diagnostic and therapeutic resources used in Italian cardiology centers for patients with the epidemiologically most relevant cardiac diseases. This article focuses on patients with unstable angina; characteristics associated with invasive procedures were specifically analyzed. METHODS AND RESULTS: Information was collected over a 2-week period on 1420 patients with unstable angina discharged from 308 cardiology centers. The mean length of stay was 9 +/- 6 days; 51% of patients were admitted to a coronary care unit (mean length of stay, 4 +/- 3 days). Noninvasive procedures included echocardiography (64%), Holter monitoring (25%), exercise stress testing (24%), and echocardiographic stress testing or nuclear imaging (7%). Invasive procedures were coronary angiography (39%) and percutaneous transluminal coronary angioplasty or coronary artery bypass grafting (13%). Unstable angina had a greater impact on invasive procedures than acute myocardial infarction. Variables independently associated with a higher rate of coronary angiographic procedures were younger age, higher technologic level of the hospital, and need for intravenous therapy. CONCLUSION: In Italy, approximately half the patients with unstable angina are admitted to hospitals without catheterization laboratories or cardiac surgery facilities. This fact supports the concept that treatments that can be administered in all types of hospitals are more likely to affect the outcome of patients with unstable angina. Overall, the rates of coronary angiography and revascularization procedures appeared low, and the setting where cardiologists practice, rather than patient characteristics, is the major determinant of the care given to patients with unstable angina.     

Cardiac Release and Kinetics of Endothelin After Uncomplicated Percutaneous Transluminal Coronary Angioplasty

This study was designed to assess the release kinetics of endothelin after percutaneous transluminal coronary angioplasty (PTCA) and to prove the coronary endothelium as the source of the endothelin release. Twenty-seven patients with single-vessel coronary artery disease underwent PTCA. Endothelin, troponin T, myoglobin, and creatine phosphokinase paired blood samples were withdrawn from the coronary sinus and a peripheral vein before the balloon maneuver and at 1, 5, 10, 30, 45 minute(s), and at 1, 2, 3, 6, 12, and 24 hour(s) after the last balloon maneuver. Myocardial ischemia was monitored by means of cardiac lactate metabolism and 12-lead electrocardiogram. Thirteen patients who underwent a diagnostic cardiac catheterization served as a control group. In the left coronary artery, PTCA (n = 19) endothelin concentrations increased from 4.1 pg/ml as a common mean baseline level before intervention to 13.9 ± 2.6 pg/ml (mean ± SD) in the coronary sinus and 7.9 ± 2.2 pg/ml (mean ± SD) in the peripheral vein at 1 minute after the intervention (p <0.001). The levels remained elevated for 3 hours with higher coronary sinus than peripheral venous concentrations due to persistant cardiac endothelin release. PTCA of the right coronary artery (n = 8) also led to an instantaneous endothelin increase from a mean concentration of 4.4 before intervention to 8.3 pg/ml after intervention with identical coronary sinus and peripheral venous levels (p <0.001). Endothelin levels gradually decreased to normal within 6 hours. No patient developed a measurable myocardial ischemia or a myocardial infarction. In the control group all parameters remained unchanged. Uncomplicated PTCA was followed by a significant cardiac endothelin release that seems to indicate endothelial injury and not myocardial ischemia.     

Beta-thromboglobulin and platelets in unstable angina

BACKGROUND. Atheromatous plaque rupture is the main cause of platelet activation in ischaemic heart disease (IHD). Platelet activation is manifested by a release into circulation of the components of granules, including beta-thromboglobulin (beta-TG) - a marker of platelet activation in vivo. The platelet count (PLT), mean platelet volume (MPV) and the proportion of large platelets (L(PLT)) are indirect platelet activation markers. Data in literature on the role of these markers in patients with unstable angina are discordant. AIM. To assess plasma concentration of beta-TG, PLT, MPV and LPLT in patients with unstable angina before and during standard pharmacological therapy. METHODS. The study group consisted of 54 patients (19 females and 35 males) with unstable angina who were divided into two groups: Group A - 45 patients with a history of angina, and group B - nine patients with a new onset unstable angina. beta-TG and platelet activation markers were measured at baseline (groups A and B) and after 8-10 days of standard medical therapy for unstable angina (group B). The control group consisted of 26 healthy subjects (13 females and 13 males). RESULTS. The mean beta-TG concentration in groups A (16.2 IU/ml) and B (19.7 IU/ml - before and 21.8 IU/ml - after treatment) was significantly (p<0.05) higher than in controls (10.6 IU/ml). In patients with unstable angina, the PLT and MPV values were not affected by therapy and were similar to those obtained in controls, whereas the LPLT value was significantly higher than in controls. CONCLUSIONS. Concentrations of beta-TG and L(PLT) are increased in patients with unstable angina due to platelet activation. The introduction of standard medical treatment for unstable angina did not significantly change beta-TG and platelet activation markers.     

Relation between serum cardiac troponin I values and severity of clinical, electrocardiographic and quantitative angiographic features in unstable angina.

This study sought to find out a correlation, if any, between serum cardiac troponin I values and extent and severity of coronary artery disease in patients with unstable angina. Eighty patients with unstable angina and normal serum creatine kinase values were studied and a comparative evaluation of serum cardiac troponin I values with clinical findings, electrocardiography, quantitative coronary angiography and follow-up events was performed. Among 80 patients, 34 (43%) had cardiac troponin I values of 0.6 microgram/L or higher (group I) and 46 (57%), below 0.6 microgram/L (group II). The mean cardiac troponin I in group I was 2.6 +/- 1.7 micrograms/L and 0.2 +/- 0.1 microgram/L in group II. The patients in group I had more type C lesions, frequent triple vessel and left main coronary artery involvement, and higher mean percentage diameter stenosis in the coronary arteries than those in group II. Early follow-up showed that more patients in group I required procedures earlier (including PTCA and CABG) than those from group II. Mid-term follow-up (9.5 +/- 4 months) data also showed greater occurrence of cardiac events (i.e. myocardial infarction and the increased need of PTCA) in group I. Patients with elevated cardiac troponin I more often experienced Braunwald's class III (A and B) unstable angina associated with presence of marked ST-T changes on the electrocardiography than those from group II. Our study suggests elevated values of serum cardiac troponin I to be evenly associated with the severity and extent of coronary lesions, clinical severity of unstable angina and marked electrocardiographic changes. Follow-up results confirm the potential value of this marker in predicting the course of coronary artery disease.     

Plasma myeloperoxidase is related to the severity of coronary artery disease

OBJECTIVE: It has been shown that the main apolipoprotein of HDL, Apo A-1, is subjected to nitration by myeloperoxidase (MPO) and this oxidative modification renders HDL proatherogenic. The aim of this study is to evaluate the relationship between plasma MPO levels, and the severity of coronary artery disease. METHODS AND RESULTS: Forty-eight patients with coronary artery narrowing and 30 control subjects were enrolled in this study. The severity of the disease was assessed by Gensini scoring after angiography. MPO concentrations were determined by using an enzyme immunoassay. A subgroup of 30 patients underwent computerized tomography to determine the calcium load of coronary arteries. Plasma MPO levels were found significantly higher in patients with coronary artery disease than controls (4.27 [1.60 to 42.43] ng/mL vs. 2.93 [1.00 to 9.25] ng/mL, P = 0.002). MPO was positively correlated with both Gensini (r = 0.228, P = 0.044) and coronary calcium scores (r = 0.433, P = 0.017). The atherosclerotic burden was more strongly correlated with MPO levels than the traditional markers such as total cholesterol and HDL. CONCLUSIONS: We found that MPO levels were elevated in patients with coronary artery disease and this increase correlated with the extent and severity of atherosclerosis. Although it is a preliminary study with a relatively small group of subjects, we suggest that MPO might be evaluated as a new marker indicating the presence and severity of coronary artery disease.     

Evaluation of fibronectin, vitronectin, and leptin levels in coronary artery disease: impacts on thrombosis and thrombolysis.

In this study, the levels of fibronectin, vitronectin, leptin, tissue plasminogen activator (t-PA), and lipid parameters were investigated in patients with coronary artery disease (CAD) and control group. The average plasma fibronectin levels in CAD patients group were significantly higher compared with the control group (p=0.006). Moreover, in patients with triple-vessel disease, plasma fibronectin levels were found to be significantly higher than those in the control group (p<0.05). Plasma vitronectin levels in patients with CAD were found to be significantly higher than those in the control group (p=0.000). In addition, in patients with double vessel disease plasma vitronectin levels were significantly higher than no vessel disease and control group, triple vessel disease was significantly higher as compared with no vessel disease, single vessel disease, and control group (p<0.05). We could not find any significant differences in t-PA values between CAD patients and control group. On the other hand, the average leptin levels in the group of patients were higher than those in the control group but there were no statistically significant differences found between them (p>0.05) because of high SD values. There was strong (+) correlation between fibronectin, vitronectin, and severity of disease [vitronectin/severity of disease, r = 0.5074 (p = 0.000), fibronectin/severity of disease, r = 0.2971 (p = 0.007)]. In conclusion, we can say that fibronectin and vitronectin have become greatly important in pathogenesis of coronary artery disease. High leptin levels may be contribute to platelet aggregation in patients with coronary artery disease. But, elevated serum levels of leptin cannot be useful diagnostic and monitoring markers in patients with coronary artery disease.     

Clinical correlation between myeloperoxidase and acute coronary syndrome

Objective To study whether myeloperoxidase (MPO) can provide prognostic information in patients with acute coronary syndromes (ACS). Methods The study population consisted of 274 consecutive patients with ACS. All patients underwent coronary angiography which showed significant coronary artery disease and blood samples were collected at admission. Follow-ups were scheduled at 1, 3, and 6 months.The end point included cardiac death, acute myocardial infarction (MI), percutaneous or surgical revascularization. Results Patients with elevated MPO serum levels (MPO ≥ 72.2 AUU/L) were more likely to have diabetics and had a history of coronary events. Kaplan-Meier event rate curves with accumulative incidence of end point at 6-month follow-up in the MPO ≥ 72.2 AUU/L group was significantly higher than in MPO<72.2 AUU/L group. Conclusions MPO may be a powerful predictor of adverse outcome in patients with ACS.(J Geriatr Cardiol 2007;4:209-212)     

NLR、MPV及hs-CRP与冠心病的临床类型及冠脉狭窄程度的关联

目的:监测中性粒细胞/淋巴细胞(NLR)、平均血小板体积（MPV）及超敏C反应蛋白（hs-CRP）3项指标在冠心病类型及冠脉狭窄程度中的临床价值。方法: 选取我院心内科行冠脉造影明确为冠心病的220例患者,其中不稳定型心绞痛(UAP)64例,急性心肌梗死(AMI)76例,对照组为稳定型心绞痛（SAP）患者80例。分别监测两组患者的白细胞计数（WBC）,中性粒细胞计数（NC）,淋巴细胞计数（LC）,hs-CRP,血小板计数（PLC）,MPV,计算NLR,分析冠心病类型及冠脉狭窄程度与3项指标的关联性。并进行多因素Logistic回归分析。结果: WBC、NLR、MPV、hs-CRP在3组的差异有统计学意义（P<0.05）,不同程度的冠脉狭窄中三者亦有统计学差异,冠脉狭窄愈严重,NLR、hs-CRP及MPV愈大（P<0.05或P<0.01）。多因素回归分析提示hs-CRP是UAP及AMI的危险因素,NLR和MPV是AMI的独立危险因素。结论: NLR、MPV、hs-CRP与冠心病临床类型及冠脉狭窄程度有关联。     

冠状动脉支架术对冠心病患者血小板活化功能的影响

目的探讨冠心病患者行冠状动脉内支架置入术前后血小板活化指标的变化,了解冠心病不同临床类型支架置入数与血小板活化指标之间的关系。方法利用流式细胞术和单克隆抗体测定48例稳定型心绞痛、45例不稳定型心绞痛患者与37例急性心肌梗死患者外周血中血小板膜糖蛋白CD62p、CD63和凝血酶敏感蛋白的阳性表达率,并与45例冠状动脉造影正常者作对照分析。结果稳定型心绞痛患者、不稳定型心绞痛患者和急性心肌梗死患者支架置入后CD62p、CD63和凝血酶敏感蛋白的阳性表达率均显著高于支架置入前(P<0.01);不稳定型心绞痛组和急性心肌梗死组治疗前亦高于对照组(P<0.01),而稳定型心绞痛组治疗前与对照组比较差异无显著性(P>0.05)。稳定型心绞痛组和不稳定型心绞痛组CD62p、CD63和凝血酶敏感蛋白的阳性表达率与支架置入个数有关,置入支架越多阳性表达率越高。结论不稳定型心绞痛患者及急性心肌梗死患者存在血小板高活化状态、动脉粥样硬化斑块破裂以及急性血栓形成。支架置入术对冠状动脉内皮的损伤加强了血小板的活化,增加了血栓形成的风险。     

Workshop: Implementation of Home Treatment Programs for Deep Vein Thrombosis with Low Molecular Weight Heparin

Increased level of soluble cell adhesion molecules may be a marker for atherosclerosis and/or reflect complication of the atherosclerotic plaque. To test whether expression of cell adhesion molecules is more pronounced in unstable versus stable coronary plaques, we measured the serum level of soluble E-selectin (sE-selectin) in 99 consecutive patients admitted to the hospital for acute coronary syndromes (ACS) and in 61 patients with chronic coronary artery disease (CAD) using a commercially available ELISA kit. We also measured the sE-selectin concentration in 20 sex- and age-matched subjects without clinical evidence of atherosclerosis, who served as controls. The mean sE-selectin level was higher in both groups of patients compared with controls (ACS, 35.0 ± 23.4 ng/mL; chronic CAD, 32.9 ± 21.0 ng/mL; controls, 14.5 ± 6.6 ng/mL; one-way ANOVA, P = 0.001), but there was no difference between patients with ACS and chronic CAD. Furthermore, there was a trend (P = 0.08) toward a decrease in sE-selectin with an increase in the extent and severity of CAD. In patients with ACS, the in-hospital cardiac event rate was 8%. Although mean sE-selectin concentration tended to be higher in patients with (49.2 ± 42.1 ng/mL) than in those without (33.8 ± 21.3 ng/mL) in-hospital cardiac events, the difference was not significant. In 53 patients with ACS, C-reactive protein was measured and showed no correlation with the sE-selectin concentration. These findings show that although sE-selectin concentration is elevated in the presence of clinically relevant atherosclerosis, it does not further increase during the unstable phase of the disease, indicating that sE-selectin is not a reliable indicator of a complicated atherosclerotic plaque.     

Markers of hypercoagulation and von Willebrand factor in postmenopausal women with unstable coronary artery disease. Discriminatory ability regarding unstable coronary artery disease and coronary atherosclerosis using receiver operating characteristics

OBJECTIVES: Many women with typical anginal chest pain have normal coronary angiograms. The pathogenetic mechanisms behind the chest pain in these patients are unknown but may be due to increased thrombogenicity. We evaluated markers of hypercoagulation and thrombosis in women with clinical signs of unstable coronary artery disease (CAD). METHODS AND RESULTS: A total of 158 patients with unstable CAD and 101 controls were examined: 16% of the patients had normal vessels and 84% had coronary atherosclerosis at coronary angiography. Mean plasma concentrations of von Willebrand factor antigen, soluble fibrin (SF), thrombin-antithrombin complex and D-dimer were significantly higher, whereas there was no difference regarding prothrombin fragment 1+2 between patients and controls. Patients with coronary atherosclerosis had higher mean plasma levels for most variables compared with those with normal coronary vessels, although only significantly higher for SF. D-Dimer was significantly higher in patients with normal coronary vessels compared with the control group. Although multivariate analyses showed strong significant correlations of the haemostatic variables to the diagnosis of unstable CAD, receiver operating characteristics (ROC) revealed that none of the variables represented high diagnostic accuracy in separating patients with unstable CAD. Likewise, none of the variables was particularly good at identifying coronary atherosclerosis. CONCLUSION: Our results are in favour of a hypercoagulable state in postmenopausal women with unstable CAD and coronary atherosclerosis, whereas this does not seem to be the case in patients with normal vessels. ROC revealed no variable to be particularly clinically useful in separating patients from controls or patients from those without coronary atherosclerosis.     

Influence of haematological parameters before coronary angioplasty on subsequent restenosis

OBJECTIVES: Restenosis is the major limitation of coronary interventions occurring in nearly a third of the patients undergoing percutaneous transluminal coronary angioplasty (PTCA) with no single, definite predictor demonstrated in an individual patient. Platelets are known to play an important role in the pathogenesis of subsequent restenosis. METHODS AND RESULTS: In a prospective study, follow-up coronary angiographies were performed in 102 consecutive patients with stable angina who underwent a successful PTCA for single-vessel coronary artery disease. Demographics, baseline lipid profiles (total cholesterol, HDL- and LDL-cholesterol, triglycerides) and haematological parameters (red cell, white cell and platelet counts, haemoglobin concentration, haematocrite %, mean platelet volume, platelet mass and fibrinogen levels) were compared between patients with and without restenosis. In the restenosis group, mean platelet volume (8.82 +/- 0.78 fl vs. 8.13 +/- 0.64 fl, p < 0.001), white cell count (8673 +/- 322 x 10(3)/microl vs. 7513 +/- 232 x 10(3)/microl, p < 0.01) and fibrinogen level (4.2 +/- 1.4 g/l vs 3.6 +/- 1.1 g/l) were significantly higher. The relative odds for developing angiographically defined restenosis were 2.49 times greater in diabetics (p = 0.11) and 2.54 times greater in men (p = 0.13). It is 1.43 times greater in patients with higher fibrinogen levels (p = 0.16). But, the relative odds for developing restenosis were 10.43 times greater in patients with larger pre-procedural mean platelet volumes (p < 0.01). CONCLUSIONS: There was a positive correlation between mean platelets volume and loss in luminal diameter between post-angioplasty and follow-up angiographies (r = +2.345, p = 0.01). There was no association between restenosis and haemoglobin, haematocrit, red cell count, white cell count, platelet count, platelet mass and plasma fibrinogen level. The development of restenosis after successful coronary angioplasty may be mainly influenced by the platelet size.     

Platelet activation in coronary artery disease: intracardiac vs peripheral venous levels and the effects of angioplasty

BACKGROUND: Platelet activation and aggregation play a key role in coronary artery disease, with antiplatelet therapies leading to improved clinical outcomes. Limited data exist as to whether peripheral venous blood measurements of platelet physical indexes (eg, platelet count, volume, and granularity) and soluble markers of platelet activation (eg, P-selectin [sP-sel] and CD40 ligand [CD40L]) reflect the local (intracardiac) coronary environment. Furthermore, how percutaneous coronary interventions (PCIs) affect levels of peripheral/cardiac platelet indexes is unclear. METHODS: Blood samples were sequentially acquired from the coronary os, aortic root, coronary sinus, and the femoral vein, and where relevant, pre-PCI and post-PCI. Eighty-seven patients undergoing coronary angiography were recruited (mean [+/-SD] age, 59.8+/-10.8 years; 54 men [62%]), of whom 36 proceeded to PCI. Platelet physical indexes and plasma sP-sel and CD40L levels were measured (by enzyme-linked immunosorbent assay). RESULTS: At baseline, no intracardiac vs peripheral differences were noted in sP sel levels, while CD40L levels were elevated in the aorta compared to the coronary sinus and femoral venous. The mean platelet count (MPC) was similar at all four sites, but within the coronary sinus blood, mean platelet volume (MPV) was significantly lower and mean platelet granularity (MPG) was higher when compared to arterial levels. Though aortic and femoral levels of sP-sel were raised following PCI, transcardiac gradients of plasma sP-sel levels were unaffected. PCI was associated with lower CD40L, MPC, and MPV levels but with a higher MPG level in all sampling sites. CONCLUSIONS: sP-sel levels measured peripherally reflect the cardiac environment, unlike CD40L, MPC, MPV, and MPG. PCI leads to further platelet activation (raised sP-sel) despite aggressive antiplatelet therapy.     

血浆氨基末端脑钠肽前体水平评价冠心病严重程度的价值

目的观察冠心病患者血浆氨基末端脑钠肽前体(NT-proBNP)水平变化,探讨血浆NT-proBNP水平评价冠心病严重程度价值。方法选择住院治疗,并行冠状动脉造影的患者205例,LVEF 75%共182例,分为急性心肌梗死(AMI)组(41例),不稳定性心绞痛(UAP)组(85例),稳定性心绞痛(SAP)组(40例)和正常组(16例);又根据冠状动脉造影分为单支病变组(52例)、双支病变组(49例)、多支病变组(64例)和零支病变组(40例)。采用Gensini积分法评价冠状动脉病变的狭窄严重程度,测定血浆NT-proBNP水平以及LVEF。结果AMI组和UAP组血浆NT-proBNP水平明显高于SAP组和正常组(P<0.05)。单支病变组、双支病变组和多支病变组血浆NT-proBNP水平明显高于零支病变组(P<0.05)。血浆NT-proBNP水平与LVEF呈负相关,与Gensini积分呈正相关。结论AMI和UAP患者血浆NT-proBNP水平明显升高,可能是冠心病危险分层的有效指标。