As the endothelium and inflammatory cells play a crucial role in the development of collaterals after a sudden or slowly progressing stenosis of coronary arteries, the levels of soluble endothelial adhesion molecules (CAMs) including vascular cell adhesion molecule (VCAM-1) intercellular adhesion molecule-1 (ICAM-1) and E-selectin were compared between patients with poor coronary collaterals and patients with well-developed collaterals.
In the study, 97 non-diabetic subjects with single-vessel disease were included. Collateral supply to the stenotic coronary artery was determined by angiographic grading system of 0–3 (Rentrop et al. J Am Coll Cardiol 1985; 5:587–592). Serum levels of adhesion molecules were measured by enzyme-linked immunosorbent assay.
Patients were divided into two groups according to the collateral degree (group A: 50 patients with grade 0 and 1; group B: 47 patients with grade 2 and 3 collaterals). The groups were well matched with respect to baseline clinical and angiographic characteristics. Levels of soluble VCAM-1 (mean±SEM; 875±26.6 versus 742.7±35.1 ng/ml; P=0.004), ICAM-1 (322.4±12.4 versus 269.4±13.3 ng/ml; P=0.005), and E-selectin (43.6±2.6 versus 33±2.4 ng/ml; P=0.004) were found to be significantly higher in group A in comparison with group B. In addition, when patients were divided into four groups according to the collateral degree, patients with grade 0 collaterals had the highest values and those with grade 3 collaterals had the lowest values for all these molecules.
We concluded that poor collateral circulation is associated with increased levels of soluble CAMs in patients with obstructive coronary artery disease. However, further studies are needed to elucidate the exact role of these inflammatory markers in the setting of poor collateral circulation.
In the present study conducted in patients with single vessel coronary artery disease, serum concentrations of soluble adhesion molecules including vascular adhesion molecule-1, intercellular adhesion molecule-1 and E-selectin were compared between patients with angiographically graded poor collaterals and those with sufficient collaterals. Our results demonstrated that all of these molecules were significantly higher in patients with poor collaterals as compared to those with sufficient collaterals. In addition, when patients were subdivided into four groups according to collateral formation; it revealed that levels of these adhesion molecules were found to be at the highest values in patients with no visible collaterals among four groups despite similar clinical and angiographic features.
Yüksek Ihtısas Hospıtal, Cardiology Clinic, Ankara, Turkey
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Received 30 April 2004 Revised 27 July 2004 Accepted 30 July 2004