Diagnostic coronary angiography is related to decreased TNF-α production after ex-vivo whole blood stimulation with LPS

Background: Several studies showed serum markers elevation as a result to coronary angiography. We investigated the effect of diagnostic coronary angiography (DCA) on the development of systemic inflammatory response syndrome (SIRS) and on whole blood cytokine production capacity after ex-vivo LPS stimulation. Methods: In this observational study, clinical characteristics and serum cytokines of the patients were recorded at baseline and at 2, 6, 12, and 24 h after DCA. Peripheral blood was collected at baseline and at 2, and 24 h for complete blood count, coagulation profile and ex-vivo (100 μl) stimulation with LPS (500 pg) for subsequent cytokine measurement. Values are expressed as median ± IQR and were compared using Wilcoxon's signed rank test with Bonferroni adjustment. Results: We included 23 male patients (mean age 52.0 ± 18.0 years) undergoing DCA. None of the patients developed clinical or laboratory signs of SIRS. Serum IL-6 significantly increased at 12 h. There was a significant decrease in TNF-α production after ex-vivo LPS stimulation of whole blood at 2 and 24 h compared to baseline (median ± IQR; 716.0 ± 319.0; 576.0 ± 715.0 vs. 1154 ± 844.0 pg/ml; respectively) suggesting that DCA may cause transient endotoxin tolerance. Conclusions: DCA is related to increased serum IL-6 levels but does not cause clinical SIRS. Development of SIRS after DCA is indicative of other in origin complication. DCA is associated with immune cells hyporesponsiveness, possibly through monocyte depression, expressed as decreased TNF-α production after whole blood stimulation with LPS ex vivo.