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CLINICAL STUDY: UNSTABLE ANGINA

Combined role of the Lewis antigenic system, Chlamydia pneumoniae, and C-reactive protein in unstable angina

Dominick J. Angiolillo, MD^*, Giovanna Liuzzo, MD, PhD^*, Simona Pelliccioni, MD^*, Erica De Candia, MD, PhD, Raffaele Landolfi, MD, Filippo Crea, MD, FACC^*, Attilio Maseri, MD, FACC and Luigi M. Biasucci, MD, FACC^*,*

^* Institute of Cardiology, Milano, Italy
Internal Medicine, Catholic University of the Sacred Heart, Rome, Italy
Institute of Hematology, Catholic University of the Sacred Heart, Rome, Italy
Department of Cardiology and Cardiac Surgery, University Cuore e Salute, Milan, Italy

Manuscript received February 6, 2002; revised manuscript received November 12, 2002, accepted November 19, 2002.

^* Reprint requests and correspondence: Dr. Luigi M. Biasucci, Institute of Cardiology, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Roma, Italy.
biasucci{at}tiscali.it

OBJECTIVES: The goal of this study was to assess the prognostic role of the Lewis antigenic system, Chlamydia pneumoniae (CP) seropositivity (CP+), and C-reactive protein (CRP) levels in unstable angina (UA).

BACKGROUND: The role of CP infection in acute coronary syndromes is contradictory. The Lewis antigenic system, a genetically determined blood group system associated with infections and several disorders, including ischemic heart disease, might influence the susceptibility to CP infection, inflammatory response, and risk of cardiac ischemic events.

METHODS: The CRP levels, Lewis antigens, and CP+ were measured in 54 patients with Braunwald’s class IIIB UA. All patients were followed up for one year, and the occurrence of new coronary events (coronary death, myocardial infarction, and recurrence of instability) were recorded.

RESULTS: Twenty-five coronary events occurred during follow-up. At univariate analysis CRP >3 mg/l (CRP+) (p = 0.0056), Lewis antigen b (Leb+) (p = 0.028), and the combination of Leb+ and CP+ (p = 0.006) and of CRP+ and Leb+ (p = 0.003) were associated with new coronary events, while CP+ alone was not. At multivariate analysis, CRP+ (p = 0.008) and combined Leb+CP+ (p = 0.03) were independent predictors of worse outcome. The event rate was 64% in CRP+ patients, 67% in Leb+CP+ patients, and 86% in CRP+Leb+CP+ patients. Combined Leb+CP+, but not Leb+ and CP+ alone, was related to CRP levels (p = 0.03). Among CP+ patients, CRP levels were higher in Leb+ than Leb- (p = 0.028).

CONCLUSIONS: Our data demonstrate that in UA the Lewis antigenic system plays an important role, probably determining individual susceptibility to the detrimental effects of CP infection and by determining an enhanced inflammatory response.

Abbreviations and Acronyms   ACS   acute coronary syndromes   CABG   coronary artery bypass grafting   CI   confidence interval   CP   Chlamydia pneumoniae   CRP   C-reactive protein   HP   Helicobacter pylori   IgG   immunoglobulin G   IHD   ischemic heart disease   Lea   Lewis a antigen   Leb   Lewis b antigen   OR   odds ratio   UA   unstable angina