Intracoronary cyclic-GMP and cyclic-AMP during percutaneous transluminal coronary angioplasty

Abstract

We investigated intracoronary cyclic-guanosine monophosphate (c-GMP) levels during percutaneous transluminal coronary angioplasty (PTCA) since experimental studies have shown the endothelial origin of c-GMP production. Intracoronary c-GMP and cyclic adenosine monophosphate (c-AMP) were measured during coronary angioplasty in 24 patients with chronic coronary artery disease. Four coronary blood samples were taken through a catheter from the coronary artery the first sample before coronary angiography and the other three from distal to coronary obstruction, as follows: before the balloon inflation, at the maximum inflation and 5 min after restoration of coronary flow. c-GMP increased from 7.9 ± 1.0 pmol/ml and 7.5 ± 0.9 pmol/ml before angiography and balloon inflation to 11.1 ± 1.3 pmol/ml at the maximum inflation ( P < 0.01), with a trend to decrease 5 min after the end of the intervention (9.5 ± 1.0 pmol/ml, P: NS). Intracoronary c-AMP levels remained almost unchanged. Five venous samples were taken to measure c-AMP before coronary angiography, before PTCA, and 5 min, 2 h and 24 h after PTCA. c-AMP values 2 and 24 h after PTCA (17.8 ± 1.7 pmol/ml and 17.5 + 1.7 pmol/ml, respectively) were lower than the highest value (22.1 ± 2.1 pmol/ml) found 5 min after PTCA, ( P < 0.001). c-GMP increases distal to coronary obstructive lesion during PTCA at the time of balloon inflation, while c-AMP remains unchanged. c-AMP rises in venous circulation only. PTCA stimulates the mechanism of c-GMP release, while systemic c-AMP increase seems to be related to the stress occurring during catheterisation and PTCA.