[Soluble selectins in myocardial infarction]. / Rozpuszczalne selektyny w zawale miesnia sercowego.

UNLABELLED: In myocardial infarction, the endothelial activation which induces leukocytes migration into the myocardial tissues, may play an important role in ischemic injury. Selectins, shedding from the surface of activated cells into bloodstream, maybe suggested as markers of endothelial activation and leukocytes stimulation. The aim of the study was evaluation. To evaluate serum soluble E- and P-selectin levels as endothelial activation marker and serum soluble L-selectin level as leukocytes stimulation marker in myocardial infarction. MATERIAL AND METHODS: We examined 27 patients with acute myocardial infarction (AMI) The control group (K) consisted of 23 healthy subjects without symptoms of coronary artery disease. The concentration of soluble selectins (sE-, sP-, sL-selectin) were analyzed in venous blood serum. Results of routine laboratory tests: lipid levels, leukocyte count, prothrombin time were also included into statistical analysis. RESULTS: A significant decrease in serum sL-selectin level was observed in patients with acute myocardial infarction compared to the control group. However, no difference was found in sE- and sP-selectin levels between the patient group and the control group. The sE-selectin level correlated positively with triglicerides level and inversely with HDL cholesterol level. There were a positive correlation between sP-selectin level and leukocyte count as well as inverse correlation between sP-selectin level and prothrombin time. The sL-selectin level correlated positively with leukocyte count. There were also a positive correlation between sP-selectin level and sE-selectin as well as sL-selectin levels. CONCLUSIONS: The sE-selectin level increases with the severity of atherogenic changes in serum lipid profil, and sP-selectin level increases due to inflammatory and prothrombotic processes. The sL-selectin level is influenced by inflamamatory processes in the vascular wall. The sE- and sP-selectin levels, unchanged compared to the control group, do not reflect adequately the degree of endothelial activation. An decreased sL-selectin level may indicate functional depletion of leukocytes in patients with myocardial infarction and make it difficult to assess the degree of leukocytes stimulation.

Inhibitors of sodium-glucose transport protein 2: A new multidirectional therapeutic option for heart failure patients.

Several mechanisms have been suggested to explain positive cardiovascular effects observed in studies with sodium-glucose co-transporter 2 (SGLT2) inhibitors. The reduction in glucose reabsorption in proximal tubuli induced by SGLT2 inhibitors increases urinary glucose and sodium excretion resulting in increased osmotic diuresis and consequently in decreased plasma volume, followed by reduced preload. In addition, the hemodynamic effects of SGLT2 inhibition were observed in both hyper and euglycemic patients. Due to the complex and multidirectional effects induced by SGLT2 inhibitors, this originally antidiabetic group of drugs has been successfully used to treat patients with heart failure as well as for subjects with chronic kidney disease. Moreover, their therapeutic potential seems to be even broader than the indications studied to date.

Effect of Low High-Density Lipoprotein Level on Endothelial Activation and Prothrombotic Processes in Coronary Artery Disease-A Pilot Study.

High-density lipoproteins (HDL) play an important role in the prevention of atherosclerosis. The aim of the study was to assess the relationship between serum HDL-C concentration and proinflammatory/prothrombic activation in coronary artery disease (CAD) patients. The study group included 27 acute myocardial infarction (AMI) patients and 30 stable angina pectoris (SA) patients. The control group consisted of 23 people without cardiac symptoms. In the AMI and SA groups, a lower HDL-C and a higher LDL-C/HDL-C index were observed. The SA patients had lower total cholesterol, LDL-C, sE-selectin ligand, as well as higher triglycerides and CD40 concentration in comparison with both the control and AMI groups. A higher von Willebrand Factor and intercellular adhesion molecule-1 were found in both study groups. Low HDL-C concentration in the CAD patients may intensify pro-inflammatory endothelial activation and prothrombotic processes. A low concentration of HDL-C and a high value of the LDL-C/HDL-C index seem to be better indices of atherogenic processes than the LDL-C concentration alone.

Value of oral glucose tolerance test in the acute phase of myocardial infarction.

BACKGROUND: Although European guidelines advise oral glucose tolerance test (OGTT) in patients with acute myocardial infarction (AMI) before or shortly after hospital discharge, data supporting this recommendation are inconclusive. We aimed to analyze whether disturbances in glucose metabolism diagnosed before hospital discharge in AMI patients represents a latent pre-existing condition or rather temporary finding. Additionally, we planned to investigate the value of pre-selected glycemic control parameters as predictors of long-term glucometabolic state. METHODS: We assessed admission glycemia, glycated hemoglobin, mean blood glucose concentration on days 1 and 2 in 200 patients with a first AMI but without overt disturbances of glucose metabolism. We also performed OGTT at discharge and 3 months after discharge. RESULTS: The prevalence of disturbances in glucose metabolism (as assessed by OGTT) at 3 months was significantly lower than at discharge (29% vs. 48%, p = 0.0001). Disturbances in glucose metabolism were not confirmed in 63% of patients with impaired glucose tolerance and in 36% of patients with diabetes mellitus diagnosed during the acute phase of AMI. Age >77 years, glucose ≥ 12.06 mmol/l at 120 minutes during OGTT before discharge and mean blood glucose level on day 2 >7.5 mmol/l were identified as independent predictors of disturbances in glucose metabolism at the 3-month follow-up. CONCLUSIONS: Disturbances in glucose metabolism observed in patients with a first AMI are predominantly transient. Elderly age, high plasma glucose concentration at 120 minutes during OGTT at discharge and elevated mean blood glucose level on day 2 were associated with sustained disturbances in glucose metabolism.

Diurnal variation in platelet inhibition by clopidogrel.

Morning increase in the occurrence of myocardial infarction, stroke and sudden cardiac death is a well-recognized phenomenon, which is in line with a morning enhancement of platelet aggregation. We investigated whether platelet inhibition during clopidogrel and aspirin therapy varies during the day. Fifty-nine consecutive patients (45 men and 14 women) with first ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary interventions (pPCI) on dual antiplatelet therapy were prospectively enrolled into the study. Blood samples were collected 4 days after start of clopidogrel treatment at 6.00 a.m., 10.00 a.m., 2.00 p.m. and 7.00 p.m. Arachidonic acid and adenosine diphosphate (ADP)-induced platelet aggregation were assessed by impedance aggregometry. Platelet inhibition by clopidogrel was lowest in the midmorning: median ADP-induced platelet aggregation was 55%, 17% and 27% higher at 10.00 a.m. compared to 6.00 a.m., 2.00 p.m. and 7.00 p.m., respectively (p < 0.002). Nonresponsiveness to clopidogrel defined according to the device manufacturer was 2.4-fold more frequent in the midmorning than in the early morning. We observed a more pronounced midmorning increase in ADP-induced platelet aggregation in diabetic patients when compared to non-diabetics. In contrast, no diurnal variation in the antiplatelet effect of aspirin was observed. In conclusion, in patients presenting with STEMI undergoing pPCI, platelet inhibition by clopidogrel is less strong in the midmorning hours. This periodicity in platelet aggregation in patients on dual antiplatelet therapy should be taken into consideration when assessing platelet function in clinical studies.

[ECG changes in patients with stroke]. / Udar mózgu jako przyczyna zmian w EKG, które byly powodem wykonania koronarografii.

We present a case of a male patient who was admitted to the cardiology department with a diagnosis of NSTEMI (deep negative T waves in all precordial leads). Two weeks earlier he was hospitalised because of a stroke caused by thrombosis of the left carotid artery. He had no angina. An ECHO showed a normal myocardial contractility of the left ventricle. The concentration of troponin I was also normal. No coronary artery stenosis was revealed in coronary angiography. We present a review of studies devoted to ECG changes in patients with stroke.

Gender differences and in-hospital mortality in patients undergoing percutaneous coronary interventions.

BACKGROUND: Many observational and randomised studies have suggested that women are referred for invasive diagnostics and treatment of coronary artery disease (CAD) less frequently than men, and the effects of percutaneous coronary intervention (PCI) among women are worse than in men. AIM: To compare direct results of PCI in men and women. METHODS: The study was a retrospective assessment of case records of one thousand consecutive patients treated with PCI because of acute myocardial infarction (AMI) (344 patients), unstable angina (UA) (164 patients) and stable angina (SA) (492 patients). We examined the effects of demographic, angiographic and clinical variables on the duration of hospitalisation and in-hospital mortality separately in men and in women. RESULTS: Women constituted 30.7% of patients treated with PCI because of AMI, 39.6% of those with UA and just 25.8% of those with SA. Women were significantly older than men, had a higher BMI, and more often suffered from hypertension and diabetes. The duration of hospitalisation was the same in men and women if the reason for PCI was SA or UA, however, in case of AMI women were hospitalised significantly longer than men. In the univariate analysis gender had no influence on in-hospital mortality regardless of the reason for PCI treatment. Among the variables subjected to multivariate analysis female gender, age, BMI, diabetes, hypercholesterolaemia, indication for PCI, final TIMI flow in the target vessel and cardiogenic shock as a complication of AMI were shown to affect mortality. Significant effects on in-hospital mortality for women were exhibited only by cardiogenic shock. Among men, indication for PCI, age, diabetes and final TIMI flow in the target vessel also had a significant influence on in-hospital mortality. CONCLUSIONS: Stable angina is a reason for performing PCI more rarely in women than in men. Women with CAD are older than men and have more risk factors. The in-hospital mortality among patients treated with PCI because of SA is independent of gender. Cardiogenic shock appeared to be the only factor that influences in-hospital mortality in women. In the case of men such an influence is also observed for indication for PCI (AMI, UA or SA), diabetes and final TIMI flow in the target vessel.

[Acute myocardial infarction in a patient with iatrogenic thyrotoxicosis--a case report]. / Zawal serca u pacjenta z jatrogenna tyreotoksykoza--opis przypadku.

We present a patient with myocardial infarction and normal coronary angiogram. The patient had no classical coronary risk factors, but had thyrotoxicosis, which was taken into consideration as a possible cause of myocardial infarction.

Endothelial function in patients with chest pain and normal coronary angiograms.

BACKGROUND: A normal coronary angiogram is found in about 20% of patients who undergo coronary angiography due to chest pain. In some of them syndrome X is diagnosed. Endothelial dysfunction is one possible cause of this pathology. AIM: To compare the endothelial function estimated by two different methods in patients with typical or atypical anginal pain and with no chest pain. METHODS: Fifty-three patients who underwent coronary angiography due to suspected coronary artery disease and who had a normal coronary angiogram were included in the study: 34 patients had typical anginal pain (group 1) and 19 patients had atypical chest pain (group 2). The control group consisted with 20 subjects without chest pain. The plasma concentration of such endothelial markers as von Willebrand factor (vWF), thrombomodulin (TM), endothelin 1 (ET-1), tissue plasminogen activator (tPA), plasminogen activator inhibitor type 1 (PAI-1) and C-reactive protein were measured. We also determined endothelial-dependent brachial arterial dilatation (flow-mediated dilation, FMD). RESULTS: The groups of patients were different with regard to the factors of known effects on endothelial function but endothelial markers were not different in all groups with two exceptions. The concentration of tPA was the highest in patients with typical chest pain and the concentration of PAI-1 was the highest in patients without chest pain. The FMD values were low in all patients and there were no significant differences in the FMD values between the three analysed groups. We did not find any correlation between the concentration of examined endothelial markers and FMD. A non-significant relationship between the presence of classical risk factors and decreased FMP was observed. We have found a significant relationship between the number of risk factors and FMD, tPA, PAI-1 and hsCRP. CONCLUSIONS: The assessment of endothelial function using FMD or estimation of endothelial markers is not useful to differentiate chest pain.

Endothelial function parameters in patients with unstable angina and infection with Helicobacter pylori and Chlamydia pneumoniae.

BACKGROUND: Endothelial dysfunction may be a factor linking infection with atherosclerosis. The aim of our study was to assess the relationship between seropositivity to Helicobacter pylori (Hp) and/or to Chlamydia pneumoniae (Cp) and some endothelial function parameters in patients with unstable angina. METHODS: In 31 patients with unstable angina, we determined the serum concentration of the von Willebrand factor (vWF), thrombomodulin, tissue plasminogen activator antigen, and tissue plasminogen activator inhibitor type 1 antigen, the concentration of IgG antibodies to Hp and Cp (all by ELISA), and the level of C-reactive protein. The Western blot test was performed for all patients seropositive to Hp. It allowed us to identify 15 different antigen proteins of Hp. RESULTS: Sixty-one percent of the patients were seropositive to both Hp and Cp, and 35% were seropositive to Hp only. We did not find significant differences in serum concentrations of endothelial function parameters and CRP between the two groups of patients. The patients seropositive to both Hp and Cp had a significantly higher serum concentration of vWF when Hp did not contain the 95 kDa protein (p=0.01) and a significantly higher serum concentration of PAI-1:Ag when Hp did not contain the 57 kDa protein (p=0.002) and the 66 kDa protein (p=0.02). CONCLUSION: The results show that the antigenic profile of bacteria may play a more significant role in coronary artery disease than seropositivity.

[Recurrent restenosis in patient with single vessel coronary artery disease]. / Nawracajaca restenoza u chorej z jednonaczyniowa choroba wiencowa.

We present a patient with a single-vessel coronary artery disease, who during 5.5 years underwent 6 coronary intervention procedures -- 3 stent implantations including one drug eluting stent -- TAXUS, 2 balloon coronary angioplasty procedures and CABG. The choice of the optimal therapeutic method in patients with single-vessel coronary artery disease is discussed.

Associations between selected angiographic parameters and the number of CD34⁺ cells and plasma levels of vascular endothelial growth factor and angiogenin in patients with ST-segment elevation myocardial infarction.

INTRODUCTION: Left ventricular (LV) function and prognosis in patients after myocardial infarction are associated with some angiographic parameters. OBJECTIVES: The aim of the study was to assess the associations between the TIMI score in the infarct-related artery (IRA) before percutaneous coronary intervention (PCI), myocardial blush grade (MBG) following effective PCI, and the extent of collaterals measured using the Rentrop scale and plasma levels of vascular endothelial growth factor (VEGF) and angiogenin, number of CD34⁺ cells, as well as LV ejection fraction (LVEF) and wall motion score index (WMSI). PATIENTS AND METHODS: In 62 patients with the first ST-segment elevation myocardial infarction (STEMI) treated with PCI and bare metal stent implantation, plasma VEGF and angiogenin levels as well as the number of CD34⁺ cells were assessed before PCI, 24 hours after PCI, at discharge, and at 30 days following STEMI. LVEF and WMSI were evaluated by echocardiography at discharge and at 1 and 6 months after STEMI. RESULTS: Patients with TIMI 0-1 flow in the IRA before PCI (64.6% of the patients) had significantly higher troponin I and VEGF levels as well as a higher number of CD34⁺ cells than patients with TIMI 3 flow. Patients with TIMI 0-1 flow also had worse LV systolic function at 1 and 6 months following STEMI. Neither the MBG grade nor the Rentrop score showed associations with the mobilization of CD34⁺ cells, VEGF and angiogenin levels, and parameters of L V systolic function. CONCLUSIONS: Early patency of the IRA and lower myocardial necrosis seem to be more important for LV function assessed in patients 6 months after STEMI than mobilization of CD34⁺ cells and levels of angiogenic factors.

Effect of parathormone on heart rate variability in hemodialysis patients.

INTRODUCTION: Parathormone (PTH) is a very potent uraemic toxin, which affects heart structure and function. PTH also plays the role in uraemic autonomic neuropathy (AN). The aim of the study was to investigate the relationship between high PTH level and AN assessed with frequency domain measures of heart rate variability (HRV). MATERIALS AND METHODS: A 24-h ECG was performed in 40 HD (F=19, M=21) patients aged 49+/-11 years, duration of HD therapy 37+/-30 months. Frequency domain measures of HRV were obtained according to European Society of Cardiology recommendations. Total spectral power (TP), high frequency band (HF) and low frequency band (LF) were computed as indexes of: total autonomic nervous system (ANS) activity, parasympathetic and sympathetic activities, respectively. LF/HF ratio was calculated. TP, HF, LF and LF/HF were expressed as natural logarithm. Patients were divided into two groups due to PTH level: PTH+ (PTH> or =275 pg/ml) and PTH- (PTH<275 pg/ml). RESULTS: The values of lnTP and lnLF were lower in patients PTH+ than in patients PTH- (6,58+/-0,76 vs. 6,99+/-0,44 ms2, p<0,05, and 4,91+/-0,99 vs. 5,33+/-0,65 ms2, respectively, p=0,06). We also found negative correlation between lnPTH and lnTP (r=-0,47; p<0,005), lnPTH and lnLF (r=-0,35; p<0,05), lnPTH and lnHF (r=-0,34; p<0,05). On multiple regression analysis, lnTP, lnLF and lnHF were independently related to lnPTH. CONCLUSIONS: Parathormone exerts effect on activity of both parts of autonomic nervous system: sympathetic and parasympathetic. High PTH level deteriorates total autonomic activity.

[Cardiac tamponade as a cause for exploratory laparatomy - a case report]. / Tamponada serca jako przyczyna laparotomii zwiadowczej.

We present a case of 39-year-old male with symptomatic cardiac tamponade due to neoplastic disease. Because of abdominal symptoms the patient was diagnosed as having acute abdomen and underwent exploratory laparatomy which revealed enlarged liver and ascites. Correct diagnosis was established later by echocardiography and effective pericardiocentesis was performed. Diagnostic difficulties in patients with cardiac tamponade are discussed.

[Acute myocardial infarction in a patient with normal coronary arteries--a case report]. / Ostry zawal serca przy niezmienionych angiograficznie tetnicach wiencowych.

A case of a 72-year-old female who was admitted for elective dual-chamber pacemaker implantation, is presented. A few hours after the procedure the patient developed chest pain with ST-segment elevation in ECG and a significant increase in the troponin I level. An acute myocardial infarction was diagnosed. Urgent coronary angiography revealed normal coronary arteries without spasm. Possible causes of acute myocardial infarction following pacemaker implantation are discussed.

Endothelial dysfunction in acute coronary syndrome without ST segment elevation in the presence of Helicobacter pylori infection.

BACKGROUND: Helicobacter pylori (H. pylori) infection is one of the most common chronic infections in humans. While a causative relationship between H. pylori infection and several gastrointestinal disorders has been well established, the association between this condition and the development of atherosclerosis and coronary artery diseases (CAD) is less clear. AIM: To examine the relationship between H. pylori infection and endothelial function in patients with acute coronary syndrome (ACS) without ST segment elevation. METHODS: The study group consisted of 31 patients (17 males aged 38-78 years and 14 females aged 45-80 years) with ACS and without ST segment elevation in whom we measured antibodies to H. pylori and haemostatic factors indicating endothelial function, such as von Willebrand factor (vWF), thrombomodulin (TM), tissue plasmin activator (tPA:Ag), tPA inhibitor (PAI-1:Ag) and fibrinogen. RESULTS: The proportion of patients with H. pylori seropositivity was 93.5%. No significant relationship between parameters of endothelial function and IgG antibodies to H. pylori were found. There was a significant association between antibodies to p54 protein and vWF (p=0.027) and between antibodies to p33 protein and PAI:Ag concentration (p=0.019). CONCLUSIONS: These results suggest that the type of H. pylori antigens and antibodies to these antigens rather than the presence of IgG antibodies to H. pylori may play a role in the development of CAD.

Antibodies to Chlamydia pneumoniae and haemostatic factors in acute coronary syndrome without ST segment elevation.

BACKGROUND: Various chronic infections, including Chlamydia pneumoniae (C. pneumoniae), are regarded as one of the possible factors which initiates, progresses and exacerbates atherosclerotic process. The relationship between C. pneumoniae infection and haemostatic factors which also may promote atherosclerosis, has not yet been established. AIM: To assess the relationship between C. pneumoniae-specific IgA and IgG serum antibodies and haemostatic factors in patients with acute coronary syndrome (ACS). METHODS: The study group consisted of 31 patients (17 males, mean age 62 years, and 14 females, mean age 60.6 years) with ACS and without ST segment elevation in whom antibodies to C. pneumoniae and such haemostatic factors as von Willebrand factor (vWF), thrombomodulin (TM), tissue plasmin activator (tPA), tPA inhibitor (PAI-1) and fibrinogen were measured. RESULTS: The proportion of patients with C. pneumoniae seropositivity was 35.4% in our study which is lower than that reported in literature. No significant relationship between vWF, TM, tPA and PAI-1 levels, and C. pneumoniae infection was found whereas a significant (p=0.05) relationship between C. pneumoniae-specific IgG antibodies and fibrinogen level was detected. CONCLUSIONS: Excluding fibrinogen, the presence of antibodies to C. pneumoniae is not associated with increased levels of haemostatic factors in patients with ACS without ST segment elevation.

[Coronary artery stenting in the treatment of 5-fluorouracil-induced unstable angina]. / Stentowanie wiencowe w leczeniu dusznicy bolesnej niestabilnej ujawnionej w trakcie farmakoterapii 5-fluorouracylem.

Cardiotoxicity is a rare but very serious side effect of 5-fluorouracil (5-FU) treatment. Many theories have been suggested to explain the mechanism of this problem. Most commonly, coronary artery spasm is considered responsible in cardiovascular toxicity. Ischemic symptoms and signs related to 5-FU therapy are observed during the late phase of the administration of the drug. The close and careful monitoring of all patients, especially the ones with pre-existent coronary artery disease, during 5-FU infusion is mandatory. Because there is not a single and effective modality of prevention of 5-FU cardiotoxicity, the patients should be selected carefully for its administration, 5-FU infusion should be stopped as soon as symptoms are encountered. A case of a 58-year-old woman treated with 5-FU due to colon cancer is described. In the late phase of 5-FU administration, the patient developed anginal pain with transitional ST segment elevation in ECG. Patient, after coronary angiography, was successfully treated with percutaneous coronary intervention. Interventional methods, most of all stent implantation, seem to be the best treatment of 5-FU-related acute coronary syndromes.

Does mobilisation of CD34+ stem cells along with VEGF, angiogenin, IL-6, IL-8, and hsCRP levels allow predicting the direction of left ventricular ejection fraction and wall motion score index changes in patients with myocardial infarction?

BACKGROUND: Left ventricular (LV) systolic function is a significant prognostic factor in patients after myocardial infarction (MI). Multiple angiogenic and inflammatory factors are involved in postinfarction LV remodelling process. In addition, CD34+progenitor cells mobilised from bone marrow and tissue niches participate in regeneration of the infarcted myocardium. AIM: To examine relationships between LV ejection fraction (LVEF) and wall motion score index (WMSI) and the number of CD34+ cells and plasma levels of vascular endothelial growth factor (VEGF), angiogenin and such inflammatory factors as interleukin 6 (IL-6), interleukin 8 (IL-8), and high-sensitivity C-reactive protein (hsCRP) in patients with ST-elevation MI (STEMI). METHODS: The study group included 61 patients with STEMI treated with primary percutaneous coronary intervention (PCI)involving bare metal stent implantation. Plasma levels of the evaluated angiogenic and inflammatory factors were measured by flow cytometry at 4 time points (just before PCI, 24 h later, at hospital discharge, and 30 days after STEMI). LVEF and WMSI were measured by echocardiography at hospital discharge, 1 month later, and 6 months later. We compared angiogenic and inflammatory factor levels in patients with no improvement of the LV systolic function during the follow-up (group 1, n = 22)vs. those with improved LV systolic function (group 2, n = 39). RESULTS: No differences in the levels of VEGF, angiogenin, IL-6, IL-8, and hsCRP, and the number of CD34+ cells were observed between the two groups. Despite this, we found significant negative correlations between hsCRP level and LVEF,and positive correlations between hsCRP level and WMSI in both patient groups, but these correlations were much stronger in group 1. We also found a significant negative correlation between WMSI at 6 months and the number of CD34+ cells measured 24 h after PCI. CONCLUSIONS: 1. Evaluation of plasma VEGF, angiogenin, IL-6, IL-8, and hsCRP levels and the number of CD34+ cells at different time points in patients with STEMI did not allow predicting the direction of changes in LVEF and WMSI. 2. Observed significant correlations between hsCRP level and LVEF and WMSI may suggest a harmful effect of inflammation on postinfarction myocardial remodelling. 3. A significant negative correlation between the number of CD34+ and WMSI suggests that increased mobilisation of these cells might have a beneficial effect on systolic function after MI.

Circulating endothelial cells in coronary artery disease.

BACKGROUND: endothelial damage and dysfunction play a crucial role in the pathophysiology of coronary artery disease (CAD). The quantification of circulating endothelial cells (CEC) in the peripheral blood is a novel method for assessing endothelial damage. AIM: to evaluate the possible diagnostic use of single quantification of CEC in peripheral blood by flow cytometry in patients with CAD. METHODS: we examined 48 patients with CAD, including 23 patients with acute myocardial infarction (AMI) and 25 patients with stable angina (SA). The control group consisted of 20 healthy subjects without symptoms of CAD. The CEC count was evaluated by flow cytometry using antibodies against CD31, CD146, and CD45. Plasma biochemical markers of endothelial damage (von Willebrand Factor [vWF], thrombomodulin [TM]) were measured by ELISA. Serum concentrations of troponin I (TnI) and lipid parameters were also included in the statistical analysis. RESULTS: A significant increase in the CEC count was found in patients with AMI compared to the control group (p < 0.05) and SA patients (p < 0.05). However, no difference was found in the CEC count between patients with SA and the control group. Increased vWF activity was found in both groups of CAD patients compared to the control group (AMI: p < 0.001, SA: p , 0.01), and vWF activity was significantly higher in AMI patients compared to SA patients (p < 0.001). Thrombomodulin concentration did not differ significantly between any patient groups and the control group. The CEC count correlated positively with vWF activity (r = 0.3852, p < 0.05) and the atherogenic index TC/HDL-C (r = 0.3844, p < 0.05) in all patients with CAD (AMI + SA). The sensitivity of CEC count for the diagnosis of an acute coronary syndrome was lower than that of TnI level on admission (39% vs 69%). CONCLUSIONS: we confirmed that CEC count in peripheral blood can be determined by flow cytometry in CAD patients with both AMI and SA. The CEC count in AMI was increased in comparison to healthy subjects and SA patients in one third of all cases. To determine whether CEC count could be used to improve the diagnosis of an acute coronary syndrome in patients with CAD, additional studies in larger patient groups would be required.