Methylated arginines in stable and acute patients with coronary artery disease before and after percutaneous...

Impairment of the nitric oxide synthase (NOS) pathway independently predicts cardiovascular events. We investigated whether plasma levels of the NOS inhibitor asymmetric dimethylarginine (ADMA), of symmetric dimethylarginine (SDMA) and of the nitrogen oxide substrate l-arginine can serve as additional staging biomarkers in stable coronary artery disease, non-ST-segment myocardial infarction (NSTEMI) and ST-segment myocardial infarction (STEMI).

Consecutive patients referred for percutaneous coronary intervention (PCI) were studied. Peripheral blood samples were drawn immediately before, immediately after and 24 h following PCI and analyzed by means of high-performance liquid chromatography.

Seventy-four patients were studied: 27 patients with stable angina pectoris (7 women, 61.4+/-1.9 years), 23 NSTEMI patients (9 women, 61.8+/-2.3 years) and 24 STEMI patients (7 women, 61.3+/-2.8 years). Plasma concentrations of ADMA and SDMA were elevated following PCI compared to before PCI but there were no differences in concentrations between STEMI, NSTEMI and stable angina patients. Plasma concentrations of l-arginine rose after PCI but remained lower in patients with STEMI than in those with NSTEMI or in stable angina patients. Medication might influence l-arginine concentrations and the use of HMG CoA reductase inhibitors and beta-adrenoceptor antagonists at study inclusion was significantly less common in STEMI patients compared to NSTEMI and stable angina patients.

l-arginine levels were lower in patients with STEMI and we found changes in ADMA levels over shorter time periods than previously considered possible. We speculate that these variations may be related to the natural history of myocardial infarction or to peri-procedural stress related to PCI.