PRIMING OF NEUTROPHILS AFTER ELECTIVE PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY IS UNRELATED TO ACCOMPANYING BRIEF MYOCARDIAL-ISCHEMIA

Objective: The purpose of this study was to investigate the effect of brief myocardial ischemia and vascular trauma induced by elective perc utaneous transluminal coronary angioplasty on in vivo 'priming' and ac tivation of neutrophils. Patients and Methods: We studied 16 patients undergoing elective coronary angioplasty for symptomatic coronary arte ry disease and a control group of seven patients undergoing diagnostic cardiac catheterization. Free radical production from purified neutro phils (Ficoll-Hypaque density gradient method) was measured indirectly by the chemiluminescence method. Myocardial ischemia during balloon i nflation was assessed by serial lactate determinations from coronary s inus and arterial blood. The degree of transient angioplasty-related m yocardial ischemia was related to the oxidative response of activated neutrophils. Results: Mean (+/-S.E.M,) oxidative response, i.e. the lu cigenin-and luminol-enhanced-chemiluminescence (counts per minute) of neutrophils sampled from the coronary sinus increased significantly af ter percutaneous transluminal coronary angioplasty (Lucigenin-chemilum inescence: pre-angioplasty 3.69+/-0.64X10(5) vs. post angioplasty 7.08 +/-1.2X10(5), P<0.01; Luminol-chemiluminescence: pre-angioplasty 2.81/-0.67X10(6) vs. post-angioplasty 5.2+/-0.92X10(6), P<0.01). Twelve of 16 patients developed transient cardiac lactate production (mean coro nary sinus lactate excess: +0.12 mmol/l) and three disclosed a lactate extraction ratio <10%, both suggestive of myocardial ischemia. Howeve r, there was no correlation between the cardiac lactate production and the increased oxidative response after coronary angioplasty (r(2) (Lu cigenin-chemiluminescence)=0.02, n.s.; r(2) (Luminol-chemiluminescence )=0.06, n.s.). Conclusion: 'Priming' of neutrophils, as reflected by i ncreased oxidative response, is likely to occur after coronary angiopl asty, but not after the angiographic procedure itself. However, 'primi ng' seems to be unrelated to the transient brief period of myocardial ischemia and rather depends on an alternative mechanism. (C) 1997 Else vier Science Ireland Ltd.