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CLINICAL STUDY: ACUTE CORONARY SYNDROMES

Evidence of prolonged inflammation in unstable angina and non–Q wave myocardial infarction

^a Royal City of Dublin Hospital Research and Education Institute, Department of Cardiology, St. James’s Hospital, Dublin, Ireland

Manuscript received July 21, 1999; revised manuscript received March 15, 2000, accepted April 28, 2000.

Reprint requests and correspondence: Dr. J. Brendan Foley, Department of Cardiology, St. James’s Hospital, Dublin 8, Ireland

OBJECTIVES

This study was designed to document the inflammatory response up to one year after acute presentation with unstable angina (UA) and non–Q wave infarction (NQMI) as reflected by the expression of soluble cell adhesion molecules (CAMs).

BACKGROUND

Coronary plaque inflammation is a key component in the pathogenesis of acute coronary syndromes. Cell adhesion molecules are critical mediators of the inflammatory process. Soluble forms of these molecules are detectable in serum and are elevated acutely in patients with UA and NQMI.

METHODS

Patients presenting with UA and NQMI had serum samples taken at presentation and then after three, six and 12 months. A control group of similar age and gender distribution was used for comparison. Levels of soluble inter-cellular adhesion molecule-1, vascular cell adhesion molecule-1, endothelial-selectin and platelet-selectin were measured using an ELISA technique.

RESULTS

We studied 91 patients (M/F = 73/18, mean age 62 ± 11 years, 56 UA and 35 NQMI) and 24 controls (M/F = 18/6, mean age 56 ± 12 years). Levels of all four soluble CAMs were significantly elevated in both UA and NQMI patients at presentation, three and six months in comparison with controls. Levels in UA and NQMI groups fell between six and 12 months after initial presentation.

CONCLUSIONS

The results suggest that the inflammatory stimulus triggering expression of CAMs is sustained for up to six months after presentation with either UA or NQMI and then returns toward control values over the following six months.

Abbreviations and Acronyms   ANOVA = analysis of variance   CAM = cellular adhesion molecule   CRP = C-reactive protein   sE-selectin = soluble endothelial selectin   sICAM-1 = soluble intercellular adhesion molecule-1   MI = myocardial infarction   NQMI = non–Q wave myocardial infarction   sP-selectin = soluble platelet selectin   SSA = serum amyloid A protein   UA = unstable angina   sVCAM-1 = soluble vascular cell adhesion molecule-1

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