Elevation Myocardial Infarction Group Research Articles

ANALYSIS OF SERUM BILIRUBIN AND LIPIDS LEVEL IN PATIENTS WITH ATHEROSCLEROTIC DISEASE

ObjectivesTo investigate the relationship between serum bilirubin concentration and lipids.MethodsTotally 1770 non-diabetes mellitus subjects who underwent elective coronary angiography (CAG) were divided into control subgroup and coronary atherosclerotic heart disease...

Serum Chitotriosidase Activity in Acute Coronary Syndrome

Inflammation is a critical participant in mediating all stages of cardiovascular disease. Studies related with chitotriosidase that was recently found to be relevant to arterial inflammation. In this study we evaluated activity of serum chitotriosidase in acute coronary syndrome patients and its relationship with cardiovascular events, cardiac enzymes and inflammatory indicators. We prospectively analyzed consecutive 30 patients with ST-segment elevation myocardial infarction, 30 patients with non ST-segment elevation myocardial infarction, 30 patients with unstable angina pectroris who were admitted to our intensive care unit and 30 healthy people (average age 56.86±10.44 years, 81 male) between Jaunary and June 2010. Details of baseline clinical characteristics, biochemical values, receiving treatment and basal ECG findings were recorded. Data of patients with coronary angiography were evaluated. Cut off value of chitotriosidase was calculated 82.00 mmol·ml-1·h-1, with 83 percent sensitivity and 72 percent spesificity. The activity of chitotriosidase in acute coronary syndrome group was 88.85±23.08 mmol·ml-1 ·h-1, where as the control group was 68.47±28.44 mmol·ml-1·h-1, respectively p=0.001).The highest activity of chitotriosidase (96.11±19.77 mmol·ml-1·h-1) was found in ST-segment elevation myocardial infarction group and the minimal activity of chitotriosidase was in the control group (68.47±28.44 mmol·ml-1·h-1) (p= 0.001). The activity of chitotriosidase in ST-segment elevation myocardial infarction and non ST-segment elevation myocardial infarction groups were significantly higher than control group (p=0.001 and p=0.045). When acute coronary syndrome groups compared to control; a positive correlation was found between chitotriosidase activity and hs-CRP (r=0.21, p= 0.046), troponin T (r=0.25, p=0.016), creatine kinase-MB (r=0.20, p=0.059). The activity of chitotriosidase is increased in acute coronary syndrome patients. Chitotriosidase is higher in ST-segment elevation myocardial infaction group than non ST-segment elevation myocardial infarction and unstable angina pectoris group.

Value of heart-type fatty acid binding protein in the clinical diagnosis of early acute myocardial infarction

A total of 115 patients with acute chest pain under the suspicion of acute myocardial infarction (AMI) were selected.By the onset time of chest pain,they were divided into two periods of ＜3 h and 3 -6 h respectively. Heart-type fatty acid binding protein (H-FABP)and such traditional cardiac biochemical markers as cardiac troponin T (cTnT),creatine kinase isoenzyme (CK-MB) and myoglobin (MYO) were tested to compare the sensitivity and specificity in the early diagnosis of AMI.The sensitivity of H-FABP was significantly higher than those of cTnT,CK-MB and MYO (P =0.026,0.005,0.048 ) ; the specificity of H-FABP was lower than those of cTnT,CK-MB in the diagnosis of AMI ( P ＞ 0.05 ).The sensitivities of H-FABP were 81.6％ and 78.1％ in the ST-elevation myocardial infarction (STEMI) and nonST elevation myocardial infarction (NSTEMI) groups respectively ( P =0.095 ).Regardless of the onset of chest pain at ＜ 3 h or 3 -6 h,the combination of H-FABP and cTnT had a higher sensitivity than those of cTnT,CK-MB and MYO in the early diagnosis of AMI (P =0.005,0.028).In the early and rapid diagnosis of AMI patients,H-FABP has a high sensitivity and a poor specificity.And it has some reference value. Key words: Heart-type fatty acid binding protein; Myocardial infarction

Association between high-sensitivity C reactive protein/Adiponectin and Resistin in patients with non-ST elevation acute coronary syndrome

ObjectiveTo screen the association between high-sensitivity C-reactive protein/adiponectin and resistin in patients with non-ST elevation acute coronary syndrome.MethodsThe study population consisted of 106 patients with non-ST elevation acute coronary syndrome,...

Comparison of two clinical scoring systems in risk stratification of non-ST elevation acute coronary syndrome patients in predicting 30-day outcomes

BackgroundNon-ST elevation acute coronary syndromes (NSTEACS) confer a broad range of risk of adverse outcomes following presentation to an emergency department. This study compares the Thrombolysis in Myocardial Infarction (TIMI)...

Gamma glutamyltransferase levels and its association with high sensitive C-reactive protein in patients with acute coronary syndromes.

Background:Elevated Gamma-glutamyltransferase (GGT) level is independently correlated with conditions associatedwith increased atherosclerosis, such as obesity, elevated serum cholesterol, high blood pressure and myocardial infarction. It is also demonstrated that serum gamma-glutamyltransferase activity is an independent risk factor for myocardial infarction and cardiac death in patients with coronary artery disease. Although the relationship between gamma-glutamyltransferase and coronary artery disease has been reported, not many studies have shown the relationship between changes ofgamma-glutamyltransferase in acute coronary syndromes and a well established coronary risk factor high sensitive C-reactive protein. (hs-CRP).Aims:In this study, how gamma-glutamyltransferase levels changed in acute coronary syndromes and its relationship with high sensitive C-reactive protein if any were studied.Patients & Methods:This trial was carried out at Kosuyolu Cardiovascular Training and Research Hospital and Van Yuksek Ihtisas Hospital, Turkey. 219 patients (177 males and 42 females) presenting with acute coronary syndrome, and 51 control subjects between September 2007 and September 2008 were included in the study. Serum gamma-glutamyltransferase, high sensitive C-reactive protein, serum lipoprotein levels and troponin I were determined.Results:Serum gamma-glutamyltransferase and high sensitive C-reactive protein levels were higher in acute coronary syndrome patients compared to control. There was also correlation between gamma-glutamyltransferase and high sensitive C-reactive protein levels.Conclusion:Serum gamma-glutamyltransferase and high sensitive C-reactive protein levels were higher in acute coronary syndrome patients. In subgroup analyses, the higher difference with Non-ST elevation myocardial infarction and ST elevation myocardial infarction groups than unstable angina oectoris group proposes a relationship between gamma-glutamyltransferase and severity of acute coronary syndromes.

In-hospital outcomes of emergent and elective percutaneous coronary intervention in octogenarians

Although the prevalence of coronary artery disease increases with age, elderly patients are underrepresented in clinical trials. We sought to describe the short-term outcomes of octogenarians undergoing percutaneous coronary intervention (PCI) in both emergent and elective settings. We retrospectively identified all octogenarians undergoing PCI at our institution from January 2002 to December 2005. The outcomes of those undergoing primary PCI for ST-segment elevation myocardial infarction (group A) were compared with a randomly selected cohort of octogenarians undergoing elective PCI (group B). Group A comprised 91 patients and group B 88 patients. Procedure success was high with Thrombolysis in Myocardial Infarction grade 3 flow achieved in greater than 90% of patients in both groups. Group A experienced more postprocedure morbidity including acute renal failure (47 vs. 8%) and bleeding requiring transfusion (51 vs. 17%) (P<0.0001 for both comparisons). In-hospital mortality was higher in group A (21 vs. 0%). In multivariate analysis, the risk of in-hospital mortality was predicted by lower admission systolic blood pressure (odds ratio 1.026 per point decrease in systolic blood pressure; 95% confidence interval 1.003-1.049; P = 0.030) and development of cardiogenic shock (odds ratio 7.506; 95% confidence interval, 1.865-30.207; P = 0.005). Mortality in group A was significantly higher among patients with cardiogenic shock (42 vs. 6%, P<0.001). PCI is a safe and highly effective procedure in octogenarians during both emergent and elective settings. However, elderly patients undergoing primary angioplasty who develop hemodynamic instability during ST-segment elevation myocardial infarction remain at increased risk for mortality. Measures to reduce postprocedure bleeding and renal dysfunction may improve outcomes among elderly patients undergoing PCI.

A017 The biomarkers of coronary events study (biocore): from plasma sampling to discovery of new circulating biomarkers of atherosclerosis using differential proteomic analysis

In spite of important therapeutic advances during the last 20 years, coronary atherothrombotic complications are and will remain the first cause of death all over the world. Acute coronary syndromes (ACS) are unpredictable and can lead to sudden death before any medical treatment. The development of new strategies for the screening of patients susceptible to develop an ACS is thus of major interest. We hypothesized that coronary artery disease, in its stable and unstable forms, is associated with modifications of the concentrations of various circulating proteins (circulating proteome), which could be assessed using a new method for pre-treatment of plasma (equalization) before differential proteomic analysis. Every step from blood sampling to the proteomic analysis (nature of the tubes used, centrifugation time and speed, conditions of storage etc.) was strictly standardized Three groups of 30 patients were studied: non-ST elevation myocardial infarction (group 1), stable angina (group 2), angiographically normal coronary arteries without extra-coronary atherosclerosis (group 3). Five milliliters of plasma from each patient were equalized; this methodology (ProteominerTM, Biorad) is based on a solid-phase ligand library of hexapeptides which provides a potential ligand for every protein in the biological sample, with a limited capacity of binding for abundant proteins, thus allowing enrichment in low abundance proteins/peptides. Various strategies of elution have been used in order to increase the number of peaks/spots detected by SELDI-TOF mass spectrometry and by 2D-electrophoresis, respectively. Several differential peaks are currently being identified. The screening, prognostic and therapeutic values of the new biomarkers discovered using this novel approach will require further validation, using more straightforward assays (eg, ELISA) in case-control and prospective cohorts of patients with coronary artery disease.

Osteoprotegerin and B-type natriuretic peptide in acute coronary syndromes with preserved systolic function: Relation to coronary artery disease extension

Objectives To analyze Osteoprotegerin (OPG), and BNP plasma levels in patients with non-ST elevation acute coronary syndrome (NSTE-ACS), in relation to clinical presentation and to coronary atherosclerosis diffusion. Methods 155 CAD patients were classified in four groups: stable angina (SA n = 42), unstable angina (UA n = 35) non-ST elevation myocardial infarction (NSTEMI n = 45) and control group ( n = 33), measuring OPG and BNP at hospital admission. We compared both biomarkers in relation to the number of coronary narrowed vessels (1-,2-,3 or more vessels disease), and to the stenoses degree by Duke Jeopardy score. Results OPG levels were higher in patients with CAD respect to controls ( p < 0.0001). Patients with SA showed more elevated levels than controls (2.6 ± 1.2 vs 7.4 ± 5.0 pmol/l p < 0.01). However patients with UA and NSTEMI had higher OPG level with respect to SA patients (12.2 ± 7.8 and 11.6 ± 6.1 respectively pmol/l p < 0.001). A positive relation was found between OPG levels and coronary plaques extension by Duke Jeopardy score ( r = 0.65). BNP levels were higher in patients with UA/NSTEMI respect to controls and SA patients ( p < 0.001). Besides, BNP was significantly higher in patients with multi-vessels vs 1-vessel disease ( p < 0.001). Conclusions Patients with UA and NSTEMI show high OPG and BNP levels. OPG increase seems related to the number of plaques in the coronary vessels, suggesting its involvement in the CAD progression.

Diurnal variation of soluble CD40 ligand in patients with acute coronary syndrome. Soluble CD40 ligand and diurnal variation

Introduction We sought to investigate whether day-night variations occur in the concentration of circulating soluble CD40 ligand in patients with acute coronary syndrome, as this may have practical implications. Materials and Methods We assessed 70 consecutive ST-segment elevation myocardial infarction patients admitted into the Coronary Care Unit and 50 control subjects. Each subject was studied under strictly controlled light/dark conditions. Blood samples were drawn at 09:00 h (light phase) and 02:00 h (dark phase). Nocturnal blood samples were drawn by a trained nurse, with the help of a minute torch with a dim red light in order to avoid any direct lighting on the patient during sleep. The soluble CD40 ligand was measured using a commercially available ELISA. Results Soluble CD40 ligand levels showed no diurnal variations in control subjects. In the ST-segment elevation myocardial infarction group, however, soluble CD40 ligand concentration (pg/mL) in the light phase was significantly higher than that in the dark phase (167.3 ± 63.2 vs 118.9 ± 48.3 pg/mL, p < 0.001). Conclusions The study shows for the first time the existence of diurnal variations in soluble CD40 ligand levels in ST-segment elevation myocardial infarction patients, which indicates the need for standardizing the time of blood sampling for the assessment of this molecule, at least in studies involving ST-segment elevation myocardial infarction patients.

Osteoprotegerin and B-type natriuretic peptide in non-ST elevation acute coronary syndromes: Relation to coronary artery narrowing and plaques number

BackgroundTo analyse osteoprotegerin (OPG), and B-type natriuretic peptide (BNP) levels in patients with non-ST elevation acute coronary syndrome (NSTE-ACS), in relation to clinical presentation and to coronary atherosclerosis diffusion. OPG has been found in several tissues, including the cardiovascular system, BNP is selectively produced by myocardial cells. Methods178 consecutive patients were classified in three groups: stable angina (SA), unstable angina/non-ST elevation myocardial infarction (NSTE-ACS) and control group, measuring OPG and BNP at hospital admission. We compared both biomarkers in relation to the number of coronary narrowed vessels (1-, 2- , 3- or 4- vessels disease), and to the stenoses degree by Duke Jeopardy score. ResultsOPG levels were higher in patients respect to controls (p<0.0001). Patients with SA showed more elevated levels than controls (2.6±1.2 vs 7.4±5.0 pmol/l p<0.01). However patients with NSTE-ACS had higher OPG level with respect to SA patients (11.8±7.1 pmol/l p<0.001). A positive relation was found between OPG levels and number of coronary plaques by Duke Jeopardy score (r=0.65). BNP levels were higher in patients with NSTE-ACS respect to controls and SA patients (p<0.001). Besides, BNP was significantly higher in multivessels vs 1-vessel disease (p<0.001). ConclusionsPatients with NSTE-ACS show high OPG levels. OPG increase seems related to the number of plaques in the coronary vessels, suggesting its involvement in the coronary disease progression. BNP is also increased during NSTE-ACS and more associated to coronary narrowing.

Cigarette smoking and acute coronary syndromes: A multinational observational study

Purpose To determine the impact of cigarette smoking on the presentation, treatment, and in-hospital outcomes of patients admitted with the full spectrum of acute coronary syndromes. Methods GRACE is a multinational observational registry involving 94 hospitals in 14 countries. This analysis is based on 19,325 patients aged at least 18 years admitted for acute coronary syndromes as a presumptive diagnosis with at least one of the following: electrocardiographic changes consistent with acute coronary syndromes, serial increases in serum biochemical markers of cardiac necrosis, and/or documentation of coronary artery disease. The main outcomes measured were mode of presentation, treatment and in-hospital death in the ST-segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction, and unstable angina groups to assess the impact of smoking status. Results Smokers were more frequently diagnosed with ST-segment elevation myocardial infarction (46.0%) than former smokers (27.4%) and non-smokers (30.2%) ( P<0.001). Smokers were mostly men, were younger and more aggressively treated than former smokers and non-smokers across the three acute coronary syndrome groups. Unadjusted in-hospital mortality rates were lower in smokers compared with former smokers and non-smokers in the study population (3.3%, 4.5%, and 6.9%, respectively, P<0.001), and in the ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction groups. However, by multivariate logistic analysis, the adjusted in-hospital mortality rate was similar regardless of smoking status. Conclusions There is no survival advantage related to current or prior cigarette smoking in patients admitted with acute coronary syndromes, regardless of presentation. In this large multinational registry, the smokers' paradox does not exist.