Circulation. 1999;100:e96
(Circulation. 1999;100:e96.)
© 1999 American Heart Association, Inc.
Circulation Electronic Pages |
Enhanced Inflammatory Response to Coronary Angioplasty in Patients With Severe Unstable Angina
Uichi Ikeda, MD;
Yukihiro Hojo, MD;
Takaaki Katsuki, MD;
Kazuyuki Shimada, MD
From Department of Cardiology, Jichi Medical School, Tochigi, Japan
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To the Editor:
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We read with interest the recent article by Liuzzo et al
1
concerning
the enhanced inflammatory response to PTCA in
patients with
severe unstable angina. They found that PTCA induced an
increase
in plasma interleukin-6 (IL-6) levels in patients with severe
unstable
angina, but IL-6 levels did not change after PTCA in stable
patients.
We previously reported that plasma IL-6 levels become elevated in
patients with acute myocardial infarction2 and that IL-6
mRNA is expressed in human atherosclerotic lesions.3
Therefore, we propose that the main source of plasma IL-6 in
coronary artery diseases is the vascular tissue. Recently, we
measured the levels of IL-6 and von Willebrand factor (vWF), a
marker of endothelial injury, in the coronary
sinus blood of patients with stable angina. Blood samples were taken
from the coronary sinus immediately before and after and 4 and
24 hours after either PTCA (group A; n=52) or diagnostic
coronary angiography (group B; n=7). Levels of IL-6 and vWF in
the coronary sinus blood did not change in group B after
coronary angiography. Conversely, in group A, the levels of
IL-6 and vWF increased significantly 4 hours after the procedure from
the baseline value of 3.34±0.56 to 8.20±0.63 pg/mL
(P<0.01) and from 113±6.2% to 130±7.3%
(P<0.01), respectively, and reached peak values at 24 hours
(13.2±1.20 pg/mL and 139±7.4%, both P<0.01 versus
baseline). Furthermore, there was a significant positive correlation
between IL-6 and vWF levels in the coronary sinus blood at both
4 hours (r=0.38, P<0.01) and 24 hours
(r=0.43, P<0.01), suggesting that the mechanism
of increased IL-6 after PTCA is related in part to local vascular
injury.
Although Liuzzo et al1 found an increase in plasma IL-6
levels after PTCA only in patients with severe unstable angina, we
suspect that if blood samples were drawn from the coronary
sinus rather than the peripheral vein, more definite
conclusions regarding the involvement of inflammatory cytokines
in the pathogenesis of acute coronary syndrome could be
obtained.
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References
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Liuzzo G, Buffon A, Biasucci LM, Gallimore JR,
Caligiuri G, Vitelli A, Altamura S, Ciliberto G, Rebuzzi AG, Crea F,
Pepys MB, Maseri A. Enhanced inflammatory response to coronary
angioplasty in patients with severe unstable angina.
Circulation. 1998;98:2370–2376.[Abstract/Free Full Text]
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Ikeda U, Okawa F, Seino Y, Yamamoto K, Hidaka Y, Kasahara T,
Kawai T, Shimada K. Serum interleukin 6 levels become elevated in acute
myocardial infarction. J Mol Cell Cardiol.. 1992;24:579–584.[Medline]
[Order article via Infotrieve]
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Seino Y, Ikeda U, Ikeda M, Yamamoto K, Misawa Y, Hasegawa T,
Kano S, Shimada K. Interleukin-6 gene transcripts are expressed in
human atherosclerotic lesions. Cytokine.. 1994;6:87–91.[Medline]
[Order article via Infotrieve]
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To the Editor:
References