Markers of Inflammation and Multiple Complex Stenoses (pancoronary Plaque Vulnerability) in Patients with Non-ST Segment Elevation Acute Coronary Syndromes

Overview

Journal Heart

Date 2004 Jul 16

PMID 15253949

Citations 26

Authors

P Avanzas

R Arroyo-Espliguero

J Cosin-Sales

G Aldama

C Pizzi

J Quiles

J C Kaski

Affiliations

Soon will be listed here.

Abstract

Objective: To assess the relation between markers of inflammation and the presence of multiple vulnerable plaques in patients with non-ST segment elevation acute coronary syndromes.

Design: Prospective cohort study of 55 patients with non-ST segment elevation acute coronary syndromes and angiographically documented coronary disease. Blood samples were obtained at study entry for the assessment of high sensitivity C reactive protein (CRP), neopterin, and neutrophil count. Coronary stenoses were assessed by quantitative computerised angiography and classified as "complex" (irregular borders, ulceration, or filling defects) or "smooth" (absence of complex features). Extent of disease was also assessed by a validated angiographic score.

Results: Neutrophil count (r = 0.36, p = 0.007), CRP concentration (r = 0.33, p = 0.02), and neopterin concentration (r = 0.45, p < 0.001) correlated with the number of complex stenoses. Patients with multiple (three or more) complex stenoses, but not patients with multiple smooth lesions, had a higher neutrophil count (5.9 (1.4) x 10(9)/l v 4.8 (1.4) x 10(9)/l, p = 0.02), CRP concentration (log transformed) (1.08 (0.63) v 0.6 (0.6), p = 0.03), and neopterin concentration (log transformed) (0.94 (0.18) v 0.79 (0.15), p = 0.002). Multiple regression analysis showed that neopterin concentration (B = 4.8, 95% confidence interval (CI) 1.9 to 7.7, p = 0.002) and extent of coronary artery disease (B = 0.6, 95% CI 0.03 to 1.2, p = 0.04) were independently associated with the number of complex stenoses.

Conclusions: Acute inflammatory markers such as high neutrophil count, CRP concentration, and neopterin concentration correlate with the presence of multiple angiographically complex coronary stenoses. Neopterin concentration was a stronger predictor of multiple complex plaques than were neutrophil count and CRP concentration. These findings suggest that a relation exists between inflammation and pancoronary plaque vulnerability.

Citing Articles

Enhanced expression of neopterin in valve tissue of bicuspid aortic stenosis.

Inno G, Takahashi Y, Naruko T, Matsumura Y, Abe Y, Aoyama T J Thorac Dis. 2024; 16(1):191-200.

PMID: 38410556 PMC: 10894393. DOI: 10.21037/jtd-23-1360.

Neopterin, the Cell-Mediated Immune Response Biomarker, in Inflammatory Periodontal Diseases: A Narrative Review of a More than Fifty Years Old Biomarker.

Heneberk O, Wurfelova E, Radochova V Biomedicines. 2023; 11(5).

PMID: 37238968 PMC: 10215987. DOI: 10.3390/biomedicines11051294.

Functional capacity and inflammatory biomarkers as predictors for right atrial volume index in COPD patients.

Khedr L, Khedr N, Werida R Int J Cardiovasc Imaging. 2023; 39(8):1493-1504.

PMID: 37217717 PMC: 10427529. DOI: 10.1007/s10554-023-02871-5.

Assessment of Serum Neopterin as a Biomarker in Peripheral Artery Disease.

Zembron-Lacny A, Dziubek W, Tylutka A, Wacka E, Morawin B, Bulinska K Diagnostics (Basel). 2021; 11(10).

PMID: 34679610 PMC: 8534562. DOI: 10.3390/diagnostics11101911.

The Role of C-reactive Protein in Patient Risk Stratification and Treatment.

Arroyo-Espliguero R, Viana-Llamas M, Silva-Obregon A, Avanzas P Eur Cardiol. 2021; 16:e28.

PMID: 34276813 PMC: 8280753. DOI: 10.15420/ecr.2020.49.

References

Maehara A, Mintz G, Bui A, Walter O, Castagna M, Canos D . Morphologic and angiographic features of coronary plaque rupture detected by intravascular ultrasound. J Am Coll Cardiol. 2002; 40(5):904-10. DOI: 10.1016/s0735-1097(02)02047-8. View

Fuster V, Badimon L, Badimon J, Chesebro J . The pathogenesis of coronary artery disease and the acute coronary syndromes (2). N Engl J Med. 1992; 326(5):310-8. DOI: 10.1056/NEJM199201303260506. View

Goldstein J, Demetriou D, Grines C, Pica M, Shoukfeh M, ONeill W . Multiple complex coronary plaques in patients with acute myocardial infarction. N Engl J Med. 2000; 343(13):915-22. DOI: 10.1056/NEJM200009283431303. View

Asakura M, Ueda Y, Yamaguchi O, Adachi T, Hirayama A, Hori M . Extensive development of vulnerable plaques as a pan-coronary process in patients with myocardial infarction: an angioscopic study. J Am Coll Cardiol. 2001; 37(5):1284-8. DOI: 10.1016/s0735-1097(01)01135-4. View

Katritsis D, Korovesis S, Giazitzoglou E, Parissis J, Kalivas P, Webb-Peploe M . C-Reactive protein concentrations and angiographic characteristics of coronary lesions. Clin Chem. 2001; 47(5):882-6. View

Dove J, Jacobs A, Kennedy J, Kereiakes D, Kern M, Kuntz R . ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines)-executive summary: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee to revise the.... Circulation. 2001; 103(24):3019-41. DOI: 10.1161/01.cir.103.24.3019. View

Galis Z, Khatri J . Matrix metalloproteinases in vascular remodeling and atherogenesis: the good, the bad, and the ugly. Circ Res. 2002; 90(3):251-62. View

Li J, Jiang H, Huang C, Fang C, Tang Q, Xia H . Elevated level of plasma C-reactive protein in patients with unstable angina: its relations with coronary stenosis and lipid profile. Angiology. 2002; 53(3):265-72. DOI: 10.1177/000331970205300303. View

Buffon A, Biasucci L, Liuzzo G, dOnofrio G, Crea F, Maseri A . Widespread coronary inflammation in unstable angina. N Engl J Med. 2002; 347(1):5-12. DOI: 10.1056/NEJMoa012295. View

10.

Rioufol G, Finet G, Ginon I, Andre-Fouet X, Rossi R, Vialle E . Multiple atherosclerotic plaque rupture in acute coronary syndrome: a three-vessel intravascular ultrasound study. Circulation. 2002; 106(7):804-8. DOI: 10.1161/01.cir.0000025609.13806.31. View

11.

Zairis M, Papadaki O, Manousakis S, Thoma M, Beldekos D, Olympios C . C-reactive protein and multiple complex coronary artery plaques in patients with primary unstable angina. Atherosclerosis. 2002; 164(2):355-9. DOI: 10.1016/s0021-9150(02)00129-6. View

12.

Sabatine M, Morrow D, Cannon C, Murphy S, Demopoulos L, DiBattiste P . Relationship between baseline white blood cell count and degree of coronary artery disease and mortality in patients with acute coronary syndromes: a TACTICS-TIMI 18 (Treat Angina with Aggrastat and determine Cost of Therapy with an Invasive or.... J Am Coll Cardiol. 2002; 40(10):1761-8. DOI: 10.1016/s0735-1097(02)02484-1. View

13.

Naruko T, Ueda M, Haze K, van der Wal A, van der Loos C, Itoh A . Neutrophil infiltration of culprit lesions in acute coronary syndromes. Circulation. 2002; 106(23):2894-900. DOI: 10.1161/01.cir.0000042674.89762.20. View

14.

Huber C, Batchelor J, Fuchs D, Hausen A, Lang A, Niederwieser D . Immune response-associated production of neopterin. Release from macrophages primarily under control of interferon-gamma. J Exp Med. 1984; 160(1):310-6. PMC: 2187425. DOI: 10.1084/jem.160.1.310. View

15.

Ambrose J, Winters S, Stern A, Eng A, Teichholz L, Gorlin R . Angiographic morphology and the pathogenesis of unstable angina pectoris. J Am Coll Cardiol. 1985; 5(3):609-16. DOI: 10.1016/s0735-1097(85)80384-3. View

16.

Ambrose J, Winters S, Arora R, HAFT J, Goldstein J, Rentrop K . Coronary angiographic morphology in myocardial infarction: a link between the pathogenesis of unstable angina and myocardial infarction. J Am Coll Cardiol. 1985; 6(6):1233-8. DOI: 10.1016/s0735-1097(85)80207-2. View

17.

Levin D, Gardiner Jr G . Complex and simple coronary artery stenoses: a new way to interpret coronary angiograms based on morphologic features of lesions. Radiology. 1987; 164(3):675-80. DOI: 10.1148/radiology.164.3.3615865. View

18.

Falk E . Morphologic features of unstable atherothrombotic plaques underlying acute coronary syndromes. Am J Cardiol. 1989; 63(10):114E-120E. DOI: 10.1016/0002-9149(89)90242-7. View

19.

GOTSMAN M, Rosenheck S, Nassar H, Welber S, Sapoznikov D, Mosseri M . Angiographic findings in the coronary arteries after thrombolysis in acute myocardial infarction. Am J Cardiol. 1992; 70(7):715-23. DOI: 10.1016/0002-9149(92)90547-c. View

20.

Werner-Felmayer G, Werner E, Fuchs D, Hausen A, Reibnegger G, Schmidt K . Pteridine biosynthesis in human endothelial cells. Impact on nitric oxide-mediated formation of cyclic GMP. J Biol Chem. 1993; 268(3):1842-6. View