English

Abstract

BACKGROUND: Increased free radical production and impaired antioxidant defense system are being implicated in various disease conditions. Myocardial infarction is one such disease in which free radical mediated injury and antioxidant activity are largely studied. However there is controversy regarding the role of antioxidants in the pathogenesis and prognostication of patients following acute myocardial infarction. With these aspects in mind, this study was conducted with the objective to evaluate the utility of antioxidant in myocardial infarction. The serum antioxidant gap reflects the antioxidant activity of ascorbate, alpha-tocopherol, carotene, bilirubin and radical scavenging antioxidants other than albumin and uric acid Aim: 1) To assess the following parameters in acute myocardial infarction patients: a. Serum albumin b. Serum uric acid. c. Serum total antioxidant activity 2) To study the changes in the antioxidant and serum uric acid levels over a period of 3 days. Antioxidant will be calculated as follows: Antioxidant gap= Total antioxidant activity (TAA)-(serum albumin + serum uric acid) 3) To associate the changes in the serum antioxidant with the clinical prognosis of the patient. SETTINGS AND DESIGN: A Prospective follow up study consisting of patients with the diagnosis of ST segment Myocardial infarction (STEMI). 30 Patients who were admitted with the diagnosis of acute ST segment elevation myocardial infarction were included in the study. Serum total antioxidant activity, albumin, uric acid and plasma Malondialdehyde levels were measured on admission, and for the next 2 days of hospital stay. The clinical prognosis of the patients was assessed based on the TIMI scoring system for mortality rates of patients with STEMI. STATISTICAL ANALYSIS: The data was entered in Microsoft excel and analysed using SPSS 15.0, Stata 8.0, Medcalc 9.0.1 and systat 11.0 software. Repeated measures analysis of variance and student t test was used to find the significance of study parameters on different days. Significance is assessed at 5% level of significance. Chi-square test and Fisher Exact test has been used to find the significance of study parameters on categorical scale. RESULTS AND CONCLUSIONS: On analysis, it was found that increase in the total antioxidant was significantly associated with good prognosis ie, they had lower mortality rates (p=0.008) and increase in serum uric acid levels is significantly associated with higher mortality rates (bad prognosis), with a p value of 0.002. Hence it can be concluded from this study that changes in antioxidants levels following acute myocardial infarction may be of use in evaluating the clinical prognosis of the patient.