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Serum unbound free fatty acid levels (FFA_u) were measured in patients undergoing percutaneous transluminal coronary angioplasty (PTCA) using the fluorescent probe acrylodan intestinal fatty acid binding protein (ADIFAB). These are the first measurements of FFA_u under nonphysiologic conditions. In these studies, FFA_u levels were determined in 22 patients 5 minutes before and 30 minutes after the procedure. Post-PTCA FFA_u levels were higher than pre-PTCA levels in all patients. The average post-PTCA level for all patients was 103 nM, about 14-fold higher than the 7.5 nM value observed in healthy subjects. Although all patients exhibited elevated FFA_u levels after PTCA, ischemic ST-segment changes were observed in only 11 of these patients. The average post-PTCA FFA_u levels for patients with significant ST-segment changes (123 nM) were significantly higher than those in patients who did not exhibit …