Adhesion molecules in different treatments of acute myocardial infarction

Background: Tissue damage after ischemia and reperfusion involves leukocyte endothelial interactions mediated by cell adhesion molecules. This study w as designed to determine the time course of soluble adhesion molecules in p atients with acute myocardial infarction after attempted reperfusion by thr ombolysis with tissue plasminogen activator (tPA) or streptokinase (SK), or percutaneous transluminal coronary angioplasty (PTCA). Methods: In 3 x 10 randomly selected patients with acute myocardial infarct ion undergoing thrombolysis with tPA or SK, or treated with PTCA, plasma co ncentrations of soluble L-selectin, P-selectin, E-selectin, intercellular a dhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) and platelet endothelial cell adhesion molecule-1 (PECAM-1) were measured by e nzyme-linked immunosorbent assay, 30 min and 1, 2, 4, 8, 12 and 24 hours af ter intervention. Results: After thrombolysis with tPA, soluble L-selectin concentrations wer e persistently depressed and soluble PECAM-1 concentrations were elevated, compared with controls, SK and PTCA. While soluble VCAM-1 concentrations di d not differ within the first hours after interventions between the three g roups, soluble VCAM-1 rose by 24 hours after tPA thrombolysis but did not i ncrease after SK and PTCA treatment. Soluble ICAM-1 concentrations were con sistently elevated after PTCA compared with controls and thrombolysed patie nts. Soluble E-selectin was depressed after tPA thrombolysis and PTCA in co mparison with controls, while the SK group showed an increase throughout th e observation period. Soluble P-selectin was increased after PTCA and SK ly sis up to 8 hours after treatment compared with controls, but no significan t differences could be found between treatment groups. Conclusion: Adhesion molecules mediating leukocyte endothelial interactions are altered subsequent to postischemic reperfusion and by treatment with t hrombolytic agents and angioplasty. The clinical relevance of these biologi cal changes remains to be determined.