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Royal City
of Dublin Hospital Research and Education Institute, Department of
Cardiology, St James's Hospital, Dublin 8, Ireland
Correspondence to: Dr Mulvihill, Department of Cardiology, Freeman Hospital, Newcastle NE7 7DN, UK mulvihin{at}hotmail.com
Accepted 5 December
2000
OBJECTIVE
To assess prospectively the
prognostic value of soluble cellular adhesion molecules (CAMs) in
patients with unstable angina and non-Q wave myocardial infarction and
to compare their prognostic accuracy with that of C reactive protein (CRP).
DESIGN AND SETTINGProspective
observational study of patients presenting acutely with unstable angina
and non-Q wave myocardial infarction to a single south Dublin hospital.
METHODSPatients with Braunwald IIIA
unstable angina and non-Q wave myocardial infarction had serum samples
taken at presentation before initiation of antithrombotic treatment and
were followed for six months. The primary end point was the occurrence
of major adverse cardiovascular events (recurrent unstable angina,
non-fatal myocardial infarction, and cardiovascular death) at six
months. Concentrations of soluble intercellular adhesion molecule-1
(sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble
endothelial selectin, and soluble platelet selectin were measured using
an enzyme linked immunosorbent assay technique. CRP was measured with
an immunophelometric assay.
RESULTS91 patients (73 men and 18 women, mean (SD) age 61 (11) years) were studied; 27 patients (30%)
had major adverse cardiac events during the six months of follow up.
Concentration of CRP were significantly raised in patients who had an
ischaemic event (mean (SEM) 11.5 (6.4) mg/l v
5.4 (2.5) mg/l, p < 0.001). Concentrations of sVCAM-1 were also
significantly raised in the ischaemic event group (979 (30) ng/ml
v 729 (22) ng/ml, p < 0.001). Both sVCAM-1 and CRP concentrations correlated strongly with the occurrence of an
adverse event. The sensitivity of CRP > 3 mg/l and sVCAM-1 > 780 ng/ml for predicting future events was > 90%. There was no
difference in concentrations of sICAM-1, soluble endothelin selectin,
or soluble platelet selectin between event and non-event groups.
CONCLUSIONRaised concentrations of
sVCAM-1 and CRP are predictive of an increased risk of major adverse
cardiovascular events six months after presentation with unstable
angina and non-Q wave myocardial infarction. These findings suggest
that the intensity of the vascular inflammatory process at the time of
presentation is a determinant of clinical outcome in unstable coronary
artery disease.
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