HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via ISI Web of Science (6) Citing Articles via Google Scholar Google Scholar Articles by Monaco, C. Articles by Maseri, A. Search for Related Content PubMed PubMed Citation Articles by Monaco, C. Articles by Maseri, A.

CLINICAL RESEARCH: CORONARY ARTERY DISEASE

Persistent systemic inflammation in unstable angina is largely unrelated to the atherothrombotic burden

Claudia Monaco, MD, PhD^*, Elisabetta Rossi, MD, Diego Milazzo, MD, Franco Citterio, MD, Francesca Ginnetti, BSc, Giuseppe D'Onofrio, MD, Domenico Cianflone, MD^||, Filippo Crea, MD, Luigi M. Biasucci, MD, FACC and Attilio Maseri, MD, FACC^||,*

^* Cytokine Biology of Vessels, Kennedy Institute of Rheumatology and Surgery, Anesthetics and Intensive Care, Faculty of Medicine, Imperial College, London, United Kingdom
Institute of Cardiology, Universita Cattolica del Sacro Cuore, Rome, Italy
Institute of Vascular Surgery, Universita Cattolica del Sacro Cuore, Rome, Italy
Institute of Haematology, Universita Cattolica del Sacro Cuore, Rome, Italy
^|| Cardiothoracic and Vascular Department, Vita-Salute San Raffaele University, Milan, Italy

Manuscript received December 23, 2003; revised manuscript received July 19, 2004, accepted September 3, 2004.

^* Reprint requests and correspondence: Prof. Attilio Maseri, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy (Email: maseri.attilio{at}hsr.it).

OBJECTIVES: The aim of this study was to assess the relationship between systemic inflammation, atherosclerosis, and thrombosis in two distinct clinical models of atherothrombosis.

BACKGROUND: Persistent unstable angina (UA) is commonly associated with coronary thrombosis and persistent systemic inflammation.

METHODS: We assessed circulating markers of activation of the thrombotic and fibrinolytic cascades and systemic soluble and cellular markers of inflammation on admission in 40 patients with persisting UA (Braunwald class IIIB; group 1) and 30 patients with Leriche-Fontaine stage IIB-III peripheral artery disease awaiting revascularization (group 2).

RESULTS: The extent of atherosclerosis (p < 0.01) and activation of the coagulation system were greater in group 2, which had higher thrombin-antithrombin III complexes and D-dimer levels (2.7 and 24.4 µg/l, respectively), than in group 1 (2.0 µg/l and 12.9 µg/l, p = 0.02 and p = 0.0001, respectively). In contrast, C-reactive protein and interleukin-6 levels were higher in group 1 (7.6 pg/ml and 7.8 pg/ml, respectively) than in group 2 (4.5 pg/ml and 3.0 pg/ml, p < 0.01 and p = 0.03, respectively). Moreover, neutrophil activation was only found in group 1 (neutrophil myeloperoxidase content –4.0 arbitrary units vs. +3.4 arbitrary units in group 2, p < 0.0001). These differences persisted during the initial three days of hospitalization.

CONCLUSIONS: Such a large, consistent discrepancy between atherothrombotic burden and systemic inflammation suggests that atherothrombosis, by itself, is an unlikely cause of persisting, recurring UA. An understanding of the primary inflammatory mechanisms of persistent and recurrent coronary instability could open the way to novel therapeutic strategies.

Abbreviations and Acronyms   CRP = C-reactive protein   IL = interleukin   PAD = peripheral artery disease   UA = unstable angina