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Procoagulant and proinflammatory activity in acute coronary syndromes
A Manten1, R J de Winter, M C Minnema
1Center for Hemostasis, Thrombosis, Atherosclerosis, and Inflammation Research, Academic Medical Hospital, Amsterdam, Netherlands.
Insights
Interleukin-6 (IL-6) and fibrinopeptide A (FPA) are independent markers that help distinguish stable from unstable ischemic coronary syndromes. These inflammatory and hemostatic markers can elevate independently during acute phases.
Area of Science:
- Cardiology
- Biochemistry
- Immunology
Background:
- Acute coronary syndromes involve both hemostatic and inflammatory systems.
- The precise roles and interplay of these systems in disease pathogenesis are not fully understood.
Purpose of the Study:
- To investigate the relationship between coagulation system activation and proinflammatory activity in patients experiencing ischemic coronary syndromes.
- To determine the predictive value of specific markers in differentiating disease severity.
Main Methods:
- Measured thrombin-antithrombin III (TAT), prothrombin fragments F1 + 2, fibrinopeptide A (FPA), interleukin-6 (IL-6), and interleukin-8 (IL-8) in patients with stable angina (SA), unstable angina (UA), and acute myocardial infarction (AMI).
Main Results:
- Fibrinopeptide A (FPA) and Interleukin-6 (IL-6) levels were significantly elevated in patients with unstable angina (UA) and acute myocardial infarction (AMI) compared to stable angina (SA).
- FPA and IL-6 levels were higher in AMI patients than in UA patients.
- Thrombin-antithrombin III (TAT), prothrombin fragments F1 + 2, and IL-8 levels did not differ significantly across the patient groups.
Conclusions:
- Interleukin-6 (IL-6) and fibrinopeptide A (FPA) serve as independent markers with equal ability to differentiate stable from unstable ischemic coronary syndromes.
- Hemostatic and inflammatory markers can exhibit independent elevations during the acute phase of ischemic coronary syndromes.
Objectives:
Both the hemostatic and inflammatory system are thought to play a role in the pathogenesis of acute coronary syndromes. However, their respective contribution and interrelationship remain unclear, therefore, we studied the relationship between activation of the coagulation system and proinflammatory activity in ischemic coronary syndromes.
Methods:
Thrombin-antithrombin III (TAT), prothrombin fragments F1 + 2, fibrinopeptide A (FPA), interleukin-6 (IL-6) and interleukin-8 (IL-8) were measured in 50 patients with unstable angina (UA), 60 patients with acute myocardial infarction (AMI) and in 50 patients with stable angina (SA).
Results:
FPA levels were significantly higher in patients with UA and AMI than in patients with SA (p = 0.0015 and p < 0.0001), and were higher in patients with AMI than UA (p = 0.0013). Plasma IL-6 concentrations were significantly higher in patients with UA and AMI than in patients with SA (p = 0.0020 and p < 0.001), and again were higher in AMI than UA (p = 0.001). Interestingly, FPA or IL-6 elevations on admission were found in different patients. In contrast, TAT, F1 + 2 and IL-8 levels were not different between the three groups.
Conclusions:
IL-6 and FPA were shown to be independent predictive markers with equal discriminative power to distinguish stable (SA) from unstable (UA + AMI) patients. Moreover, hemostatic and inflammatory markers can be elevated independently in the acute phase of ischemic coronary syndromes.