tPA-lysis leads to reduced levels of SL-selectin in patients with acute myocardial infarction

Background

Thrombolysis is still the standard therapy for patients with acute myocardial infarction (AMI). Studies have demonstrated, that an inflammatory process is induced by the reopening of the occluded coronary artery. Adhesion of leukocytes to endothelial cells is the initial event in an inflammatory response and is mediated by expression of several adhesion molecules (e.g. selectins), leading to a reperfusion injury.

Methods

30 patients with AMI underwent treatment with tPA (n = 10), streptokinase (n = 10) or PTCA (n = 10) within 6 h, respectively. Blood samples were taken immediately prior and 1, 2, 4, 8, 12 and 24 h after treatment, as well as from 10 healthy donors. The serum levels of soluble L-selectin were measured with a commercially available EIA (R&D Europe). Statistic was performed by the Mann-Whitney-U-Test.

Results

Patients treated with tPA had significantly reduced levels of sL-selectin (P = 0.003) compared to healthy donors and to patients treated with streptokinase or PTCA (P = 0.03), respectively. Clinically, tPA-treated patients tended to have more complications and a higher reocclusion-rate, and more additional interventions were necessary.

Figure

Conclusion

The reduced circulating sL-selectin levels probably reflect an inflammatory process and could be a sign of a panendothelial activation in the occluded and then reperfused myocardial area.