The Value Of Serum Levels Of SCD40L, IL-6 And CRP In Patients With Non-ST-segment Elevation Acute Coronary Syndrome

Background Atherosclerotic diseases are the most important reason responsible for humankind mortality in the world, and its pathogenesis is not clear completely. Recent studies indicated that inflammatory reaction plays a critical role in the initiation, progression and acute complication of atherosclerosis. CD40L-CD40 signaling pathway is one of the potent promoters responsible for the initiation, progression and acute complication of atherosclerosis. CD40L is highly expressed before atherosclerotic plaque disrupting. Acute coronary syndrome (ACS) is such a group of clinical symptoms that arise from the disruption of unstable plaques and the formation of thrombus in coronary artery. The disruption of unstable plaques and the formation of thrombus often result in myocardial ischemia and/or necrosis. According to the ST-segment deviation in electrocardiogram (ECG), ACS was divided into ST-segment elevation ACS (STEMI) and non-ST-segment elevation ACS (including UA and NSTEMI). It is presently recognized that invasive treatment (primary PCI) should be applied to the patients with STEMI. However, it remains controversial whether the invasive treatment (primary PCI) should be also applied to the patients with non-ST-segment elevation ACS. Recent studies demonstrated that invasive treatment can improve the prognosis for the patients with high risk, but not for those with low risk. On the contrary, it may increase unnecessary invasive operations. Therefore, it is important to assess the risk of the patients with non-ST-segment elevation ACS. Objectives This study sought to investigate the relationship between stability ofcoronary plaque and serum levels of soluble CD40 ligand (sCD40L), interleukin-6 (IL-6) and C-reactive protein (CRP). It also explored the predicting value of serum levels of sCD40L, IL-6 and CRP on risk stratification and prognosis in patients with non-ST-segment elevation ACS.Methods Seventy-nine in-hospital patients with angina (including SA and UA) or NSTEMI from October 2002 to May 2003 were divided into three groups including twenty-one stable angina (SA), thirty-three unstable angina (UA) and twenty-five non-ST-elevation myocardial infarction (NSTEMI). In addition, there were twenty-seven healthy subjects for physical examination served as control group. Peripheral venous blood samples were taken from the patients with UA or NSTEMI within 6h after symptom onset and the patients with SA or controls before breakfast. Serum levels of sCD40L and IL-6 were determined by enzyme linked immunosorbent assay (ELISA). Serum levels of CRP were measured by ultra-sensitive immunoassay. Meanwhile, fifty-eight patients with non-ST-segment elevation ACS, including thirty-three UA and twenty-five NSTEMI, were respectively re-divided into two groups according to the levels of sCD40L, IL-6 and CRP (respectively 5ng/ml, 5pg/ml, 10mg/L). The major adverse cardiovascular events (MACE), including recurrent ischemic angina, recurrent nonfatal myocardial infarction and cardiac sudden death, were analyzed in each group during in-hospital and follow-up period (six months).Results (1)Serum levels of sCD40L were significantly higher in the UA group (4.61 +0.88ng/ml) and in the NSTEMI group (4.75+0.68ng/ml) than in the SA group (2.15+0.75ng/ml) and in the control group (1.98+0.73ng/ml) (respectively, P<0.01). Serum levels of IL-6 were significantly higher in the UA group (4.58 +0.85pg/ml) and in the NSTEMI group (4.74+0.95ng/ml) than in the SA group (2.54+0.86pg/ml) and in the control group (2.27+0. 83pg/ml) (respectively, P<0.01). Serum levels of CRP were significantly higher in the UA group (9.36 + 0. 97mg/L) and in the NSTEMI group (9.59+1.10mg/L) than in the SA group (2.27+0.91mg/L) and in the control group (2.29 + 0.94mg/L) (respectively, P<0.01). (2)During in-hospital and follow-up period, the incidence of MACE was significantly higher in the sCD40L>5ng/ml group (68.42%) than in the sCD40L<5ng/ml group (2.56%) (P<0.001). The incidence ofMACE was significantly higher in the IL-6>5pg/ml group (50.00%) t...