Elevated Levels of Inflammatory and Vasoactive Factors in the Culprit Coronary Artery of Acute Myocardial Infarction

Abstract

Distal embolization of the thrombus and plaque debris, as well as the release of inflammatory and vasoactive factors are suggested as important factors that may jeopardize successful myocardial reperfusion during primary coronary intervention. However, there are currently few clinical data on the presence and the role of such factors. We performed in 18 acute myocardial infaction patients primary percutaneous coronary intervention(PCI) with the distal protection device of distal occlusive balloon type, PercuSurge GuideWire system. We collected blood samples from the femoral artery before PCI and from culprit coronary artery using Export aspiration catheter after predilation while inflating the distal protection balloon and after completing PCI with deflation of the distal protection balloon. We determined concentrations of C-reactive protein, soluble CD40 ligand, IL-6, serotonin, tissue factor, and factor VIIa inblood samples. The concentrations of soluble CD40 ligand(2.84±3.74 vs 0.98±0.63 ng/mL, p= 0.004), IL-6(33.67±32.63 vs 17.08±21.41 pg/mL, p<0.001), serotonin(2.05±0.76 vs 0.92±0.60 ng/mL, p<0.001), tissue factor (257.17±84.34 vs 154.60±87.99 pg/mL, p<0.001) and factor VIIa(34.30±27.30 vs 24.19±28.00 ng/mL, p=0.016) were significantly higher in the culprit coronary artery after the first predilation than those in the peripheral blood before PCI. However, the CRP concentrations in the samples from the culprit coronary artery and the femoral artery did not differ significantly(4.15±3.19 vs 4.60±3.68 mg/L, p=0.056). The blood samples from coronary artery after multiple aspirations showed reduced concentrations of soluble CD40 ligand(2.84±3.74 to 1.64±1.96 ng/mL, p=0.030), IL-6(33.67±32.63 to 22.44±21.87 ng/mL, p=0.010), serotonin(2.05±0.76 to 1.29±0.82 ng/mL, p<0.001), tissue factor(257.17±84.34 to 198.45±95.14 ng/mL, p=0.001) and factor VIIa(34.30±27.30 to 27.65±27.24 ng/mL, p=0.001) compared to those in the coronary aspirates obtained after first balloon dilation of the culprit lesions. We found increased levels of soluble inflammatory and vasoactive factors such as soluble CD40 ligand, IL-6, serotonin, tissue factor and factor VII in the aspirate from the culprit coronary artery compared to those in peripheral blood. The aspiration of blood from culprit lesion during PCI resulted in significantly reduced concentrations of inflammatory and vasoactive markers.