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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

View larger version (123K): [in a new window]   Figure 1 Typical discrepancy in atherosclerotic burden between patient with unstable angina (UA) and peripheral artery disease. Right (A) and left (B) coronary angiograms in a patient with UA with a single coronary artery stenosis in the proximal segment of the left anterior descending coronary artery; the C-reactive protein (CRP) level was 57 mg/l and the D-dimer value was 3.7 µg/l. Femoral (C) and tibial (D) angiograms of a patient with peripheral vascular disease with multiple atherosclerotic plaques and occlusions; the CRP level was 3.7 mg/l and the D-dimer value was 107.4 µg/l.

View larger version (29K): [in a new window]   Figure 2 A discrepancy between activation of the coagulation cascade and circulating inflammatory markers in unstable angina (UA) (open boxes) and peripheral artery disease (PAD) (shaded boxes). Thrombin-antithrombin III complexes (TAT) (A) and D-dimers (DD) (B) were significantly higher in patients with PAD than in patients with UA. Conversely, interleukin (IL)-6 (D) and C-reactive protein (CRP) levels (C) were significantly higher in patients with UA than in patients with PAD. Moreover, activation of neutrophils, indicated by the significant reduction of their myeloperoxidase content (MPXI) (E) was only present in patients with UA. Data are shown as the median values, 25% to 75% interquartiles, and range.