INCREASED NEOPTERIN IN PATIENTS WITH CHRONIC AND ACUTE CORONARY SYNDROMES

Objectives. The aim of our study was to determine neopterin levels in patients with chronic and acute coronary syndromes. Background. In chr onic and acute coronary syndromes the release of different cytokines a ctivates cellular defense. Infiltration of neutrophils and monocytes/m acrophages is detected in the vessel wall as well as in the myocardium . Neopterin, which is a by-product of the guanosine triphosphate-biopt erin pathway, is a marker for those activated macrophages. Methods. We studied 123 subjects: 1) 21 consecutive patients (17 men, 4 women; me an age +/- SD 66 +/- 15 years, range 31 to 87) with acute myocardial i nfarction (AMI); 2) 62 consecutive patients (50 men, 12 women; mean ag e 61 +/- 8 years, range 43 to 81) with signs and symptoms of clinicall y stable coronary artery disease (CAD); and 3) 40 healthy blood donors (28 men, 12 women; mean age 35 +/- 13 years), Neopterin levels were d etermined with a commercially available enzyme-linked immunosorbent as say method. Results. In patients with AMI before thrombolytic therapy, neopterin levels were significantly higher than levels in patients wi th CAD and control subjects (13.7 vs. 8.6 and vs. 6.8 nmol/liter, p < 0.0001). Values also differed significantly between patients with CAD and control subjects (p < 0.0001). Neopterin levels in patients with A MI were measured seven times during a 72-h period, Within group compar ison showed significant differences over this period (p < 0.00001). Th e lowest value (11.4 nmol/liter) was observed after 4 h and differed s ignificantly from the initial value and values after 24 and 72 h (p < 0.05). After 72 h, neopterin increased to 14.9 nmol/liter, a value sig nificantly different from all values other than the initial one. There was no correlation between neopterin and creatine kinase (CK); CK, MB isoenzyme; or lactate dehydrogenase as markers for the extent of the myocardial infarction during the observation period. Conclusions. Our data support the hypothesis of an activation of monocytes and macropha ges in patients with an acute or chronic coronary syndrome. Neopterin as a marker for macrophage activation is significantly increased in pa tients with chronic CAD and more pronounced in patients with AMI short ly after the onset of symptoms. (C) 1997 by the American College of Ca rdiology.