CLINICAL STUDIES
Enhanced inflammatory response in patients with preinfarction unstable angina
Giovanna Liuzzo, MD*  ,
Luigi M. Biasucci, MD, FACC* ,
J. Ruth Gallimore, BSc* ,
Giuseppina Caligiuri, MD* ,
Antonino Buffon, MD* ,
Antonio G. Rebuzzi, MD* ,
Mark B. Pepys, MD* and
Attilio Maseri, MD, FACC*
* Department of Cardiology, Catholic University, Rome, Italy
Immunological Medicine Unit, Department of Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, London, W12 ONN, United Kingdom
Manuscript received December 7, 1998;
revised manuscript received June 15, 1999,
accepted August 18, 1999.
Reprint requests and correspondence: Dr. Giovanna Liuzzo, Department of Cardiology, Catholic University, Largo A. Gemelli, N. 8-00168 Rome, Italy
OBJECTIVES
We assessed the extent and the time course of the acute phase response following myocardial cell necrosis and its relationship with the presence of preinfarction unstable angina (UA).
BACKGROUND
Elevated levels of acute phase proteins have been reported in patients with UA and in patients with acute myocardial infarction (MI).
METHODS
C-Reactive Protein (CRP), serum amyloid A protein (SAA) and interleukin-6 (IL-6) were measured in 36 patients with MI admitted within 3 h from symptoms onset. All patients had normal levels of creatine kinase and of troponin T on admission, rising above diagnostic levels within 6 to 12 h. Blood samples for CRP, SAA and IL-6 measurements were taken on admission, at 6, 24, 48, 72 h and at discharge.
RESULTS
Twenty of the 36 patients studied presented an unheralded MI (Group 1); the remaining 16 patients had symptoms of unstable angina in the preceding 7 days (Group 2). Group 2 patients have much higher levels of CRP and SAA on admission (median values 8.8 vs. 3 mg/L and 28 vs. 3.4 mg/L, respectively, all p < 0.001). Following the necrotic insult, despite similar infarct size and clinical signs of reperfusion, Group 2 patients had strikingly higher peaks of IL-6 (median values 85.2 vs. 19 pg/ml, p < 0.05), CRP (50 vs. 31.4 mg/L, p < 0.05) and SAA (228 vs. 45 mg/L, p < 0.001).
CONCLUSIONS
Our data demonstrated that the acute phase response is greatly enhanced in patients with preinfarction UA compared with those presenting with an unheralded MI. The significant differences in acute phase response observed in these two clinical presentations of MI indicate a major difference in their underlying pathogenetic components.
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Abbreviations and Acronyms
| | CAD | = coronary artery disease | | CI | = confidence interval | | CK | = creatine kinase | | CRP | = C-reactive protein | | EF | = ejection fraction | | IL-6 | = interleukin-6 | | MI | = myocardial infarction | | SAA | = serum amyloid A protein | | SK | = streptokinase | | UA | = unstable angina | | WM | = wall motion score |
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X. Z. Ruan, J. F. Moorhead, J. L. Tao, K. L. Ma, D. C. Wheeler, S. H. Powis, and Z. Varghese
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May 1, 2006;
26(5):
1150 - 1155.
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|
|
|
|
|
|
|
S. De Servi, M. Mariani, G. Mariani, and A. Mazzone
C-Reactive Protein Increase in Unstable Coronary Disease: Cause or Effect?
J. Am. Coll. Cardiol.,
October 18, 2005;
46(8):
1496 - 1502.
[Abstract]
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[PDF]
|
|
|
|
|
|
|
G Liuzzo, G Giubilato, and M Pinnelli
T cells and cytokines in atherogenesis
Lupus,
September 1, 2005;
14(9):
732 - 735.
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|
|
|
|
|
|
|
H. Methe, S. Brunner, D. Wiegand, M. Nabauer, J. Koglin, and E. R. Edelman
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J. Am. Coll. Cardiol.,
June 21, 2005;
45(12):
1939 - 1945.
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|
|
|
|
|
|
|
W. Maier, L. A. Altwegg, R. Corti, S. Gay, M. Hersberger, F. E. Maly, G. Sutsch, M. Roffi, M. Neidhart, F. R. Eberli, et al.
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March 22, 2005;
111(11):
1355 - 1361.
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|
|
|
|
|
|
|
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January 18, 2005;
45(2):
238 - 243.
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|
|
|
|
|
|
|
R. Glaser, F. Selzer, D. P. Faxon, W. K. Laskey, H. A. Cohen, J. Slater, K. M. Detre, and R. L. Wilensky
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January 18, 2005;
111(2):
143 - 149.
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|
|
|
|
|
|
|
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January 1, 2005;
56(1):
35 - 42.
[Abstract]
[PDF]
|
|
|
|
|
|
|
H.-J. Priebe
Triggers of perioperative myocardial ischaemia and infarction
Br. J. Anaesth.,
July 1, 2004;
93(1):
9 - 20.
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[PDF]
|
|
|
|
|
|
|
D.J. Brull, N. Serrano, F. Zito, L. Jones, H.E. Montgomery, A. Rumley, P. Sharma, G.D.O. Lowe, M.J. World, S.E. Humphries, et al.
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November 1, 2003;
23(11):
2063 - 2069.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Kinlay, G. G. Schwartz, A. G. Olsson, N. Rifai, S. J. Leslie, W. J. Sasiela, M. Szarek, P. Libby, P. Ganz, and for the Myocardial Ischemia Reduction with Aggress
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September 30, 2003;
108(13):
1560 - 1566.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. J. Dacey, J. DeSimone, J. H. Braxton, B. J. Leavitt, S. J. Lahey, J. D. Klemperer, B. M. Westbrook, E. M. Olmstead, and G. T. O'Connor
Preoperative white blood cell count and mortality and morbidity after coronary artery bypass grafting
Ann. Thorac. Surg.,
September 1, 2003;
76(3):
760 - 764.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D Tousoulis, G Davies, C Stefanadis, P Toutouzas, and J A Ambrose
Inflammatory and thrombotic mechanisms in coronary atherosclerosis
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September 1, 2003;
89(9):
993 - 997.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. B. Ledue and N. Rifai
Preanalytic and Analytic Sources of Variations in C-reactive Protein Measurement: Implications for Cardiovascular Disease Risk Assessment
Clin. Chem.,
August 1, 2003;
49(8):
1258 - 1271.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Tomoda and N. Aoki
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May 1, 2003;
54(3):
277 - 285.
[Abstract]
[PDF]
|
|
|
|
|
|
|
A. Maseri and V. Fuster
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April 29, 2003;
107(16):
2068 - 2071.
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[PDF]
|
|
|
|
|
|
|
A. Buffon, L. M. Biasucci, G. Liuzzo, G. D'Onofrio, F. Crea, and A. Maseri
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July 4, 2002;
347(1):
5 - 12.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R.J. de Winter, G.S. Heyde, K.T. Koch, J. Fischer, J.P. van Straalen, M. Bax, C.E. Schotborgh, K.J. Mulder, G.T. Sanders, J.J. Piek, et al.
The prognostic value of pre-procedural plasma C-reactive protein in patients undergoing elective coronary angioplasty
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June 2, 2002;
23(12):
960 - 966.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D J Brull, J Sanders, A Rumley, G D Lowe, S E Humphries, and H E Montgomery
Impact of angiotensin converting enzyme inhibition on post-coronary artery bypass interleukin 6 release
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March 1, 2002;
87(3):
252 - 255.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Maseri and D. Cianflone
Inflammation in acute coronary syndromes
Eur. Heart J. Suppl.,
March 1, 2002;
4(suppl_B):
B8 - B13.
[Abstract]
[PDF]
|
|
|
|
|
|
|
C. V. Zalai, M. D. Kolodziejczyk, L. Pilarski, A. Christov, P. N. Nation, M. Lundstrom-Hobman, W. Tymchak, V. Dzavik, D. P. Humen, W. J. Kostuk, et al.
Increased circulating monocyte activation in patients with unstable coronary syndromes
J. Am. Coll. Cardiol.,
November 1, 2001;
38(5):
1340 - 1347.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. Iglesias-Garriz, F.e. Corral, M. A. Rodriguez, C. Garrote, M. Montes, and E. Sevillano
Pre-infarction angina elicits greater myocardial viability on reperfusion after myocardial infarction: a dobutamine stress echocardiographic study
J. Am. Coll. Cardiol.,
June 1, 2001;
37(7):
1846 - 1850.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Liuzzo, D. J. Angiolillo, A. Buffon, V. Rizzello, C. Colizzi, F. Ginnetti, L. M. Biasucci, and A. Maseri
Enhanced Response of Blood Monocytes to In Vitro Lipopolysaccharide-Challenge in Patients With Recurrent Unstable Angina
Circulation,
May 8, 2001;
103(18):
2236 - 2241.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Katritsis, S. Korovesis, E. Giazitzoglou, J. Parissis, P. Kalivas, M. M. Webb-Peploe, J. P.A. Ioannidis, and A. Haliassos
C-Reactive Protein Concentrations and Angiographic Characteristics of Coronary Lesions
Clin. Chem.,
May 1, 2001;
47(5):
882 - 886.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Volpato, J. M. Guralnik, L. Ferrucci, J. Balfour, P. Chaves, L. P. Fried, and T. B. Harris
Cardiovascular Disease, Interleukin-6, and Risk of Mortality in Older Women : The Women's Health and Aging Study
Circulation,
February 20, 2001;
103(7):
947 - 953.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L.M. Biasucci
C-reactive protein and dangerous liaisons
Eur. Heart J.,
October 1, 2000;
21(19):
1560 - 1562.
[PDF]
|
|
|
|
|
|
|
R. J. de Winter, J. Fischer, R. Bholasingh, J. P. van Straalen, T. de Jong, J. G.P. Tijssen, and G. T. Sanders
C-Reactive Protein and Cardiac Troponin T in Risk Stratification: Differences in Optimal Timing of Tests Early after the Onset of Chest Pain
Clin. Chem.,
October 1, 2000;
46(10):
1597 - 1603.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. A. Papanicolaou
Interleukin-6: The Endocrine Cytokine
J. Clin. Endocrinol. Metab.,
March 1, 2000;
85(3):
1331 - 1333.
[Full Text]
|
|
|
|
|
|
|
E. Rossi, L. M. Biasucci, F. Citterio, S. Pelliccioni, C. Monaco, F. Ginnetti, D. J. Angiolillo, G. Grieco, G. Liuzzo, and A. Maseri
Risk of Myocardial Infarction and Angina in Patients With Severe Peripheral Vascular Disease: Predictive Role of C-Reactive Protein
Circulation,
February 19, 2002;
105(7):
800 - 803.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
