Key result
Percutaneous coronary intervention was associated with a significant decrease in lactoferrin-bearing neutrophils and plasma lactoferrin one day post-procedure, which inversely correlated with plasma ACTH.
Observational (n=41)
No
PCI is associated with transient neutrophil activation and degranulation that declines by day 1, with changes correlating with stress hormones like ACTH and cortisol.
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PCI-associated neutrophil changes may reflect stress responses; hypothesis-generating for links to post-procedural inflammation or outcomes.
BACKGROUND: Psychosocial stress and activation of neutrophil granulocytes are increasingly recognized as major risk factors of coronary artery disease (CAD), but the possible relationship of these two factors in CAD patients is largely unexplored. Activation of neutrophils was reported to be associated with stenting; however, the issue of neutrophil state in connection with percutaneous coronary intervention (PCI) is incompletely understood from the aspect of stress and its hypothalamic-pituitary-adrenal axis (HPA) background. Thus, we aimed to study cortisol- and ACTH-associated changes in granulocyte activation in patients undergoing PCI. METHODOLOGY/PRINCIPAL FINDINGS: Blood samples of 21 stable angina pectoris (SAP) and 20 acute coronary syndrome (ACS) patients were collected directly before (pre-PCI), after (post-PCI) and on the following day of PCI (1d-PCI). Granulocyte surface L-selectin, CD15 and (neutrophil-specific) lactoferrin were analysed by flow cytometry. Plasma cortisol, ACTH, and lactoferrin, IL-6 were also assayed. In both groups, pre- and post-PCI ratios of lactoferrin-bearing neutrophils were relatively high, these percentages decreased substantially next day; similarly, 1d-PCI plasma lactoferrin was about half of the post-PCI value (all p≤0.0001). Post-PCI ACTH was reduced markedly next day, especially in ACS group (SAP: p<0.01, ACS: p≤0.0001). In ACS, elevated pre-PCI cortisol decreased considerably a day after stenting (p<0.01); in pre-PCI samples, cortisol correlated with plasma lactoferrin (r∼0.5, p<0.05). In 1d-PCI samples of both groups, ACTH showed negative associations with the ratio of lactoferrin-bearing neutrophils (SAP: r = -0.601, p<0.005; ACS: r = -0.541, p<0.05) and with plasma lactoferrin (SAP: r = -0.435, p<0.05; ACS: r = -0.609, p<0.005). CONCLUSIONS/SIGNIFICANCE: Pre- and post-PCI states were associated with increased percentage of activated/degranulated neutrophils indicated by elevated lactoferrin parameters, the 1d-PCI declines of which were associated with plasma ACTH in both groups. The correlation of plasma cortisol with plasma lactoferrin in the extremely stressed ACS before stenting, however, suggests an association of cortisol with neutrophil activation.
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Keresztes et al. (2013) conducted an observational in Coronary Artery Disease (Stable Angina Pectoris and Acute Coronary Syndrome) (n=41). Percutaneous coronary intervention vs. Pre-PCI baseline was evaluated on Change in ratio of lactoferrin-bearing neutrophils and plasma lactoferrin from post-PCI to 1 day post-PCI (p=<0.0001). Percutaneous coronary intervention was associated with a significant decrease in lactoferrin-bearing neutrophils and plasma lactoferrin one day post-procedure, which inversely correlated with plasma ACTH.
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