Systemic periostin is associated with larger infarct size and worse clinical outcomes in patients with acute coronary syndromes and periodontal disease

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Periodontal disease (PD) is associated with increased inflammation, which can contribute to atheromatous plaque rupture and consequent acute coronary syndrome (ACS). Periostin (Pn) is a new biomarker associated with inflammation, being involved in the complex process of myocardial recovery after an ACS; however, the association between Pn, other inflammatory biomarkers and concomitant PD in patients with ACS has not been elucidated so far. Purpose the aim of this study was to investigate the link between serum levels of Pn, other systemic inflammatory biomarkers and their impact on the clinical evolution following an ACS. Methods this was an observational prospective study in which 92 patients with ACS and concomitant PD were enrolled. Patients were divided into two groups, according to the median value of Pn which was 30,63 ng/ ml: group 1 included 46 patients with low Pn level and group 2 included 46 patients with high Pn level. Inflammatory status was investigated using serum levels of C reactive protein (CRP), interleukin 6 (IL6), endothelial/ intravascular adhesion molecules (VCAM/ICAM), P-selectin, matrixmetalloproteases (MMP9), Albumin (Ab), Apolipoprotein B (ApoB), alkaline phosphatase (AF) and sST2. For Ab, CRP, and AF the values were recorded at baseline and on day 7. Results Patients with high Pn levels presented more frequent STEMI type myocardial infarction (p=0.0004), heart failure (p=0.002) and a longer duration of hospitalization (p=0.008) and stay in the intensive coronary care unit (p=0.004). They also expressed significantly higher levels of MMP 9 (201 ± 69,37pg/ml vs 132,7 ± 112,2 pg/ml, p = 0.003), Ab (4,08 ±0,34 mg/dl vs 3,08 ± 1,46 mg/dl p=0.02), and AF at baseline at day 7 (53,84 ± 16,2 vs 47,36 ± 16,36 UI/l p=0.022; 58,73 ± 29,91 vs 42,56 ± 16,42 UI/l, p=0.0001). Patients in group 2 had also higher levels of triglycerides (p=0.02) and LDL cholesterol (p=0.0008), as well as a higher amount of myocardial necrosis, as expressed by total creatine kinase (p=0.0004) and CK-MB (p=0.0096). However, serum levels of CRP at baseline (9,2 ± 12,87 mg/ dl vs 26,61 ± 25,59 mg/dl, p=0.0009) and at day 7 (19,25 ± 26,77 mg/dl vs 31,84 ± 29,4 mg/dl, p=0.043) were significantly lower in group 2. Conclusions In patients with ACS and PD, increased systemic levels of circulating Pn indicate a larger myocardial infarction and worse clinical outcomes, being also associated with increased levels of matrixmetalloproteases, involved in the myocardial repair.