PURPOSE:Increasing evidence supports the role of soluble CD40 ligand (sCD40L) in the pathogenesis of acute coronary syndromes but its role in risk stratification of patients presenting with chest pain, and its relation with underlying angiographic features, is unknown.
METHODS:Sera from patients presenting with chest pain to the emergency room (ER) were collected, analyzed for sCD40L and Troponin I (TnI), and the levels correlated with underlying angiographic features. Patients with known malignancies, connective tissue or autoimmune diseases were excluded. For enhanced specificity, microparticles were removed from sera using a 0.2-mm filter, before analysis by standard ELISA for sCD40L levels.
RESULTS:Total sample size was 44 with mean TnI and sCD40L levels (ng/mL) from the first encounter samples of 1.63 (normal: <0.10 ng/mL) and 2.48 (normal: <1.0 ng/mL) respectively. Mean time to first sample was 6.35 hours from symptom onset. In patients with sCD40L levels < 1.0 ng/ml, 3/44 (6.8%) had critical coronary artery disease (CAD) (triple vessel disease, left main disease, or > 70% stenosis in proximal left anterior descending artery). By comparison, of 35 patients with a first cTnI value < 0.1 ng/mL, 12 (27.2%) had critical CAD.
CONCLUSION:In conclusion, a low level of sCD40L in the first sample is better at excluding patients with critical CAD than a low level of TnI. Normal serum sCD40L level after microparticle removal needs to be defined. Further studies are necessary.
CLINICAL IMPLICATIONS:Since initial TnI levels are usually negative in patients presenting relatively early to the ER, patients presenting with chest pain tend to be downgraded from appropriate care when the initial TnI is negative. However, a low level of sCD40L would further help in risk stratification of such patients.
DISCLOSURE:Venkata Gadi, No Financial Disclosure Information; No Product/Research Disclosure Information