Widespread coronary inflammation in unstable angina

N Engl J Med. 2002 Jul 4;347(1):5-12. doi: 10.1056/NEJMoa012295.


Background: Inflammation within vulnerable coronary plaques may cause unstable angina by promoting rupture and erosion. In unstable angina, activated leukocytes may be found in peripheral and coronary-sinus blood, but it is unclear whether they are selectively activated in the vascular bed of the culprit stenosis.

Methods: We measured the content neutrophil myeloperoxidase content in the cardiac and femoral circulations in five groups of patients: two groups with unstable angina and stenosis in either the left anterior descending coronary artery (24 patients) or the right coronary artery (9 patients); 13 with chronic stable angina; 13 with variant angina and recurrent ischemia; and 6 controls. Blood samples were taken from the aorta, the femoral vein, and the great cardiac vein, which selectively drains blood from the left but not the right coronary artery.

Results: The neutrophil myeloperoxidase content of aortic blood was similar in both groups of patients with unstable angina (-3.9 and -5.5, with negative values representing depletion of the enzyme due to neutrophil activation) and significantly lower than in the other three groups (P<0.05). Independently of the site of the stenosis, the neutrophil myeloperoxidase content in blood from the great cardiac vein was significantly decreased in both groups of patients with unstable angina (-6.4 in those with a left coronary lesion and -6.6 in those with a right coronary lesion), but not in patients with stable angina and multiple stenoses, patients with variant angina and recurrent ischemia, or controls. There was also a significant transcoronary reduction in myeloperoxidase content in both groups with unstable angina.

Conclusions: The widespread activation of neutrophils across the coronary vascular bed in patients with unstable angina, regardless of the location of the culprit stenosis, challenges the concept of a single vulnerable plaque in unstable coronary syndromes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Angina Pectoris / blood
  • Angina Pectoris / immunology
  • Angina, Unstable / blood
  • Angina, Unstable / immunology*
  • Aorta / immunology
  • Biomarkers / blood
  • C-Reactive Protein / metabolism
  • Catheterization, Central Venous
  • Catheterization, Peripheral
  • Coronary Circulation / immunology*
  • Coronary Stenosis / blood
  • Coronary Stenosis / immunology*
  • Female
  • Femoral Vein / immunology
  • Humans
  • Inflammation
  • Isosorbide Dinitrate / administration & dosage
  • Male
  • Middle Aged
  • Myocardial Ischemia / blood
  • Myocardial Ischemia / immunology
  • Neutrophil Activation*
  • Neutrophils / enzymology
  • Peroxidase / blood
  • Statistics, Nonparametric
  • Vasodilator Agents / administration & dosage


  • Biomarkers
  • Vasodilator Agents
  • C-Reactive Protein
  • Peroxidase
  • Isosorbide Dinitrate