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CLINICAL STUDIES

Serum neopterin and complex stenosis morphology in patients with unstable angina

^a Coronary Artery Disease Group, Cardiological Sciences, St. George’s Hospital Medical School, London, United Kingdom

Manuscript received December 7, 1998; revised manuscript received October 25, 1999, accepted December 2, 1999.

Reprint requests and correspondence: Professor Juan Carlos Kaski, Coronary Artery Disease Research Group, Cardiological Sciences, St. George’s Hospital Medical School, Cranmer Terrace, London SW17 0RE, United Kingdom
jkaski{at}sghms.ac.uk

OBJECTIVES

We sought to assess the relation between serum neopterin concentration and complex coronary artery stenosis in patients with unstable angina.

BACKGROUND

Monocyte activation is associated with acute atheromatous plaque disruption and acute coronary syndromes. Angiographically demonstrated complex coronary stenosis is often an expression of plaque disruption. Increased serum concentration of neopterin, a pterydine derivative secreted by macrophages after stimulation by interferon-gamma, has been observed in patients with acute coronary syndromes as compared with control subjects and patients with stable angina pectoris.

METHODS

We studied 50 patients with unstable angina (32 men) who underwent coronary angiography after hospital admission. All coronary stenoses with 30% diameter reduction were assessed and classified as "complex" (irregular or scalloped borders, ulceration or filling defects suggesting thrombi) or "smooth" (absence of complex features). Serum neopterin levels were assessed within 24 h of hospital admission using a commercially available immunoassay (enzyme-linked immunosorbent assay kit, IBL, Hamburg, Germany).

RESULTS

Thirty-nine patients were classified in Braunwald class IIIb, four in class IIb and seven in class Ib. The number of complex lesions per patient was 2.6 ± 1.8 (mean ± SD). The mean neopterin concentration was 7.76 ± 3.62 nmol/liter. A significant correlation was observed between neopterin serum concentration and the presence of complex coronary stenoses (r = 0.35, p = 0.015). Multiple regression analysis showed that serum neopterin (p < 0.0001) was independently associated with the number of complex lesions. Other variables associated with complex lesions were the number of vessels with 75% stenosis (p < 0.0001), plasma creatinine (p = 0.003), triglycerides (p = 0.014) and a history of unstable angina (p = 0.032).

CONCLUSIONS

Serum neopterin concentration is associated with the presence of angiographically demonstrated complex lesions in patients with unstable angina and may represent a marker of coronary disease activity.

Abbreviations and Acronyms   CK = creatine kinase   ECG = electrocardiogram, electrocardiographic   IFN-gamma = interferon-gamma

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