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High plasma concentrations of C-reactive protein (CRP), which are predictive of a poor prognosis in patients with acute coronary syndromes,1 might reflect an inflammatory pathogenetic component. It is well known, however, that short periods of ischaemia are powerful inflammatory stimuli sufficient to induce the synthesis of acute phase reactants.2 Therefore, the acute phase response in acute coronary syndrome may simply reflect the extent and severity of myocardial ischaemia. To establish whether myocardial ischaemia is an adequate stimulus to induce an increase in CRP, its plasma concentrations were evaluated in a group of patients with chronic stable angina and normal baseline values of CRP in whom myocardial ischaemia was induced by exercise.
Fifteen patients (10 men, mean (SD) age 60 (9) years) with chronic stable angina and reproducible positive exercise testing for myocardial ischaemia participated in this study. No patient had suffered a previous myocardial infarction and mean left ventricular ejection fraction was 62 (5)%. All patients had at least one critical stenosis in the proximal two thirds of one major epicardial coronary artery. The control group consisted of nine healthy subjects (six men, mean age 61 (9) years) without evidence of ischaemic heart disease and normal …
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