Examination of inflammatory markers pentraxin 3, cyclophilin A and heparin-binding epidermal growth factor in patients with acute myocardial infarction with ST-elevation

Abstract

Poznato je da je koronarna arterijska bolest (KAB) povezana sa inflamatornim i oksidativnim procesima koji dovode do okluzije koronarnih arterija i akutnog koronarnog sindroma, najčešće infarkta miokarda sa ST-elevacijom (STEMI). Još uvek se traga za biomarkerima koji bi bili korisni u klasifikaciji bolesnika prema težini bolesti i u predviđanju budućih srčanih događaja. Svrha ove studije je da se ispitaju koncentracije pentraksina 3 (PTX3), ciklofilina A (CyPA) i heparin-vezujućeg epidermalnog faktora rasta (HB-EGF) kod bolesnika sa STEMI (N=87) u odnosu na zdrave osobe (N=193) i bolesnike sa stabilnom anginom pektoris (N=15) kako bi se utvrdilo da li su promene ovih parametara posledica hronične srčane bolesti ili im se vrednosti menjaju usled akutnih poremećaja u STEMI. Dodatno je analizirano da li primena primarne perkutane koronarne intervencije (pPCI) dovodi do oštećenja krvnih sudova srca što će se manifestovati kroz promenu u koncentracijama navedenih ispitivanih parametara. Ovi parametri su analizirani i kod bolesnika sa dijagnozom infarkta miokarda bez opstrukcije koronarnih arterija (MINOCA). Studija je pokazala da su inflamatorni biomarkeri PTX3 i HB-EGF povišeni u STEMI i da se značajno menjaju posle pPCI kod bolesnika sa opstruktivnom KAB u poređenju sa vrednostima pre procedure. MINOCA bolesnici imali su značajno više vrednosti PTX3 u odnosu na bolesnike sa STEMI. Kako bi se ispitali nezavisni prediktori visokih koncentracija PTX3 i HB-EGF kod bolesnika sa STEMI, primenjena je faktorska analiza. Faktor metaboličko-oksidativnog stresa je značajan prediktor visokih koncentracija PTX3, dok je PTX3 značajan prediktor visokih koncentracija HB-EGF. Osim toga, rezultati su pokazali da je identifikacija MINOCA etiologije ključna za lečenje ovih bolesnika u čemu, pored standardnih procedura, može pomoći određivanje koncentracije PTX3.Since the association of coronary artery disease (CAD) with inflammatory and oxidative processes that leads to the development of coronary artery occlusion and acute coronary syndrome, most commonly in the form of ST-elevation myocardial infarction (STEMI) have been recognized, biomarkers that would be useful in classifying patients according to disease severity and in predicting future cardiac events are still being sought. This study aimed to examine the concentrations of pentraxin 3 (PTX3), cyclophilin A (CyPA) and heparin-binding epidermal growth factor-like growth factor (HB-EGF) in patients with STEMI (N = 87) compared to healthy subjects (N = 193) and patients with stable angina pectoris (N = 15) to determine whether changes in these parameters are due to chronic heart disease or their values change due to acute disorders in STEMI. It was additionally analyzed whether the application of primary percutaneous coronary intervention (pPCI) leads to damage of the heart blood vessels, which will be manifested as a change in the concentrations of the examined parameters. These parameters were also analyzed in patients with the diagnosis of the myocardial infarction without coronary artery obstruction (MINOCA). This study showed that the inflammatory biomarkers PTX3 and HB-EGF are elevated in STEMI and change significantly after pPCI in patients with obstructive CAD compared to pre-procedure values. MINOCA patients had significantly higher PTX3 values compared to patients with STEMI. Factor analysis was applied to examine independent predictors of high PTX3 and HB-EGF concentrations in patients with STEMI. The metabolic-oxidative stress factor is a significant predictor of high concentrations of PTX3, while PTX3 is a significant predictor of high concentrations of HB-EGF. Besides, the results showed that the identification of MINOCA etiology is crucial for the treatment of these patients in which the determination of PTX3 concentration can help, in addition to standard procedures