Serum neopterin as a marker of severity of unstable angina

ABSTRACT

The current study aimed to assess serum neopterin level in patients with chronic stable angina and unstable angina and to assess the relation between neopterin concentration and complex coronary artery stenosis in patients with unstable angina. There is increasing evidence that inflammation plays an important role in atherogenesis and may determine plaque vulnerability. At angiography, disrupted or ulcerated plaques appear as complex stenosis. Plaque vulnerability has been shown to be a function of the increased local number of inflammatory cells within plaques, particularly activated macrophages and lymphocytes. Neopterin is a pterydine derivative produced by activated macrophages, so it can be used as a marker for severity in patients with unstable angina. Fourty patients were involved in this study [30 patients with the diagnosis of unstable angina and 10 patients with the diagnosis of chronic stable angina], ten healthy subjects of matched age and sex were involved as control group. All members of the study were subjected to complete medical history, general and local cardiac examination, 12 lead ECG, echocardiography, and the following laboratory investigations CK and CKMB, C-reactive protien, Neopterin level, serum cholesterol, LDL, HDL, triglycerides, creatinine, urea and blood glucose. Coronary angiography was done to all members of group 1 [patients with the diagnosis of unstable angina]. Our study revealed that Neopterin level was significantly higher in patients with ischaemic heart disease than in healthy controls. It was also significantly higher in patients with unstable angina than in patients with chronic stable angina. Neopterin and CRP levels were significantly correlated with the presence of multiple complex lesions in angiography. There is a strong association between neopterin level and the number of complex lesions in angiography in patients with unstable angina, so, it can be used in risk stratification in these patients