Serial measurements of acute phase proteins in patients with acute coronary syndrome.

INTRODUCTION: Levels of inflammatory markers increase in patients with acute coronary syndromes (ACS) and the magnitude of the inflammatory response has been related to clinical outcomes. The release patterns and, thereby, the time point of maximal increase for multiple inflammatory markers following an ACS are not fully defined. Our purpose was to serially measure three acute phase proteins (APPs) in patients with ACS. METHODS: We prospectively enrolled 74 consecutive patients (54 men, age 62.2 ± 9.8 years) with ACS: 38 with ST-elevation acute myocardial infarction (STEMI), and 36 with non-ST-elevation acute myocardial infarction (NSTEMI) or unstable angina (UA). Peripheral levels of alpha-1 antitrypsin (A1AT), alpha-1 acid glycoprotein (A1GP) and haptoglobin (HPT) were measured on admission, and 6, 12, 24, 48, 72 hours, 7 days and 6 months after the initial evaluation. RESULTS: Baseline levels of the APPs did not differ between the two groups. A1AT, A1GP and HPT all exhibited a similar time course among NSTEMI/UA patients, all reaching maximal values at 7 days. The markers showed an earlier increase and A1AT showed earlier peaking (at 72 hours) in STEMI patients. Peak levels were higher in patients with STEMI vs. NSTEMI/UA for all three APPs (p<0.01 for A1AT and HPT, p<0.05 for A1GP). CONCLUSIONS: A1AT, A1GP and HPT levels increase significantly in patients with ACS and display different release curves in those with STEMI versus NSTEMI or UA. Knowledge of the release patterns of APPs may determine the optimal time point of measurement and thereby enhance their potential prognostic value in the setting of ACS.

Kinetics and prognostic value of inflammatory-sensitive protein, IL-6, and white blood cell levels in patients undergoing coronary stent implantation.

BACKGROUND: The levels of interleukin-6 (IL-6), white blood cells (WBCs), and some inflammatory-sensitive proteins (ISPs), such as fibrinogen (FIB) and C-reactive protein (CRP), have been related to coronary stent restenosis. The aim was to investigate the time course of the levels of IL-6, WBC, and several ISPs, i.e. FIB, CRP, cerruloplasmin (CER), haptoglobin (HPT), alpha-1 antitrypsin (A1AT), and alpha-1 acid glycoprotein (A1GP), after successful coronary stenting in patients with stable angina and to relate them to prognosis. MATERIAL/METHODS: FIB, CRP, IL-6, CER, HPT, A1AT, A1GP, and WBC levels were measured in 40 patients with stable angina before, and 6, 12, 24, 48, and 72 hours and 6 months after successful coronary stenting. The patients were followed up for 12 months. RESULTS: FIB levels increased significantly (p<0.05) 48 hours, CRP and WBC count 24 hours, CER, HPT, A1AT, and A1GP 72 hours, and IL-6 6 hours after stenting. All the levels remained unchanged in 20 control patients undergoing coronary angiography. During follow-up, stent restenosis occurred in 7 patients. Time-course and mean values of all the studied substances did not significantly differ in patients with or without restenosis (p>0.05). CONCLUSIONS: FIB, CRP, IL-6, CER, HPT, A1AT, A1GP, and WBC levels increase significantly after stenting, but they are not related to prognosis.

Ceruloplasmin is a better predictor of the long-term prognosis compared with fibrinogen, CRP, and IL-6 in patients with severe unstable angina.

BACKGROUND: We investigated the time course and prognostic value of fibrinogen (Fib), C-reactive protein (CRP), interleukin-6 (IL-6), and ceruloplasmin (CP) in patients with severe unstable angina. METHODS: All 4 substances were measured on admission and after 6, 12, 24, 48, and 72 hours, and after 7 days and 6 months in 40 patients with Braunwald's classification class IIIB unstable angina. RESULTS: All recorded substances increased significantly; 15 patients had cardiovascular events during hospitalization and 11 patients during follow-up. The time course and the mean values of Fib, CRP, and IL-6 were similar in patients with and without complications both during hospitalization and follow-up. However, CP levels from 6 hours until 6 months were significantly higher in patients with complications during follow-up (P < .05). CONCLUSIONS: Fib, CRP, IL-6, and CP levels alter in patients with severe unstable angina. However, only CP levels were related to 12-month follow-up prognosis.